Editing Nutrition (section)

=== Refeeding Syndrome ===

Refeeding syndrome is a potentially fatal shift of fluid and electrolytes when nutrition is reintroduced to a severely malnourished patient. Insulin surges in response to the carbohydrate load and drives phosphate, potassium, and magnesium intracellularly.

* '''Hallmark finding: hypophosphatemia.''' Also hypokalemia, hypomagnesemia, thiamine depletion, and sodium and fluid retention.
* '''Consequences:''' cardiac dysrhythmias, heart failure, respiratory muscle failure, rhabdomyolysis, seizures, and death.
* '''At-risk patients:''' anorexia nervosa, chronic alcohol use disorder, prolonged fasting or nothing-by-mouth status, cancer cachexia, malabsorption, and the older adult with prolonged poor intake.
* '''Prevention:''' start feeding at low calorie loads and advance slowly over days, supplement thiamine before feeding begins, correct electrolytes before and during initiation, and monitor phosphorus, potassium, and magnesium closely along with cardiac rhythm and fluid status.