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Year : 2016  |  Volume : 17  |  Issue : 2  |  Page : 19-24

Re-feeding syndrome - A case report

1 Reader, College of Nursing, CMC, Vellore, India
2 Professor, College of Nursing, CMC, Vellore, India
3 Charge Nurse, CMC, Vellore, India

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Re-feeding syndrome is a metabolic complication that can occur when enteral or parenteral nutritional rehabilitation is initiated for severely malnourished patients.It is fatal if not recognized and treated properly. This article discusses the body’s adaptation to starvation, the pathophysiology, risk factors of re- feeding syndrome, adverse consequences which can occur in the early stages of re-feeding, and its management. It focuses on challenges faced in caring for patient during re-feeding. Starvation causes adaptive reductions in cellular activity and organ function, accompanied by electrolyte and micronutrient depletion. During starvation insulin decreases and glucagon levels rise, resulting in gluconeogenesis and the breakdown of protein and lipid. Free fatty acids and ketone bodies replace glucose as the major energy source. When nutritional rehabilitation is started the re-feeding triggers a shift from fat back to carbohydrate metabolism, with consequent insulin release, and increased shift of potassium, phosphate, magnesium, and water into the cells. In a starved individual, cardiac mass may be significantly depleted, leading to the risk of fluid overload and cardiac failure during re-feeding. Nurses play a significant role in identification and prevention of re-feeding complications.

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