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Spend #5goodminutes thinking about refeeding syndrome with #KashlakChief. Refeeding syndrome actually occurs either with decreased glucose intake or total insulin lack. Who gets this syndrome? I have seen it mostly in alcoholics who eschew food.
Spend #5goodminutes thinking about refeeding syndrome with #KashlakChief. Refeeding syndrome actually occurs either with decreased glucose intake or total insulin lack. Who gets this syndrome? I have seen it mostly in alcoholics who eschew food.
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Patients with eating disorders (especially anorexia nervosa) or diseases that restrict oral intake (esophageal cancer or stricture or Schatzki ring as examples. You can also get the syndrome from newly diagnosed type I diabetes.
Patients with eating disorders (especially anorexia nervosa) or diseases that restrict oral intake (esophageal cancer or stricture or Schatzki ring as examples. You can also get the syndrome from newly diagnosed type I diabetes.
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In all these situations, when the 2 components necessary for glycolysis are present (glucose and insulin) the body proceeds. Because these patients have decreased phosphate stores (glycolysis produces ATP) this further decreases serum phosphate levels.
In all these situations, when the 2 components necessary for glycolysis are present (glucose and insulin) the body proceeds. Because these patients have decreased phosphate stores (glycolysis produces ATP) this further decreases serum phosphate levels.
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Several years ago, our service had a patient die from hypophosphatemia. As @MelBreggs states, there are several ways that severe hypophosphatemia can kill you. Our patient had a cardiac death from ventricular fibrillation.
Several years ago, our service had a patient die from hypophosphatemia. As @MelBreggs states, there are several ways that severe hypophosphatemia can kill you. Our patient had a cardiac death from ventricular fibrillation.
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Working our way from top to bottom
- Neurological complications - seizures, coma
- Cardiac - arrhythmias, decrease contractility
- Pulmonary - decreased muscle function, therefore decrease tidal volume
- Muscle - rhabdomyolysis
- Blood - hemolysis and decreased WBC function
Working our way from top to bottom
- Neurological complications - seizures, coma
- Cardiac - arrhythmias, decrease contractility
- Pulmonary - decreased muscle function, therefore decrease tidal volume
- Muscle - rhabdomyolysis
- Blood - hemolysis and decreased WBC function
6/
Most important - the initial phosphate level does not always reveal the total body phosphate depletion. Therefore you should have a high index of suspicion and check the phosphate for the next 2 days after admission in high risk patients.
Most important - the initial phosphate level does not always reveal the total body phosphate depletion. Therefore you should have a high index of suspicion and check the phosphate for the next 2 days after admission in high risk patients.
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Pro tip - when in doubt, do not give IV glucose until you consider the possibility of thiamine and/or phosphate depletion.
We start repleting phosphate when it goes under 2. We get very worried when it drops to less than 1.
Pro tip - when in doubt, do not give IV glucose until you consider the possibility of thiamine and/or phosphate depletion.
We start repleting phosphate when it goes under 2. We get very worried when it drops to less than 1.
