What will happen if we give a large Carbohydrate diet to an already malnourished patient in the ICU❓

🔰If we introduce nutritional support ( enteral or parenteral)  based on the requirements of  a regular healthy adult, to a malnourished patient, there will be a significant rise in basal insulin secretion, which will draw Potassium and Phosphate into the cell leading to hypokalemia, hypophosphatemia and fatal fluid shifts. ( Both rapid initiation and large amounts are dangerous). Phosphate depletion is also associated with increased urinary Magnesium excretion.

🔰 It can also be associated with Renal failure, Respiratory failure, Neuromuscular failure, Cardiac failure and Arrhythmias

🔰 This is known as “Refeeding Syndrome“

🔰 So to avoid this, in patients at risk ( e.g. chronic alcoholics, those who have not eaten anything in last 5 days etc) , we should introduce nutritional support at not more than 50% of the daily requirement , for the first two days.

🔰 Feeding rates can be increased to normal levels, if there is no evidence of refeeding syndrome clinically and biochemically, thereafter.

🔰 NICE guidelines for the high risk patients : start support with a maximum 10 kCal per kg per day, with thiamine & B complex supplementation. Biochemical parameters to be monitored closely.

🔰 There is no need for Prefeeding correction of  electrolytes 

Reference: Mehanna HM, Moledina J. Refeeding syndrome: What it is, and how to prevent and treat it. BMJ. 2008; 336(7659): 1495–1498.