II. Pathophysiology

  1. Occurs in severely malnourished patients who undergo aggressive administration of Specialized Nutrition Support
  2. Rapid reintroduction of large amounts of carbohydrate
    1. Metabolism shifted to anabolic from catabolic
    2. Insulin released
    3. Cells uptake Potassium, phosphate, Magnesium, and water
  3. Results in severe electrolyte abnormalities
    1. Hypophosphatemia
    2. Hypokalemia
    3. Hypomagnesemia

III. Prevention

  1. Start refeeding at one third or less of nutritional needs and gradually increase every 5-7 days
  2. Administer Thiamine 100 mg IV daily for first week of Specialized Nutritional Support

IV. Prognosis

  1. Life threatening complication if not recognized

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