Refeeding syndrome - pathophysiology and electrolyte pattern
Core concept
- Starvation -> fat/protein catabolism, total-body phosphate, K and Mg depleted despite normal serum levels
- Intracellular stores empty; serum maintained by shift out of cells
- Carbohydrate reintroduced
- inc insulin
- cellular uptake of glucose, PO4, K, Mg
- PO4 consumed making ATP and 2,3-DPG in the glycolytic switch
- -> profound hypophosphataemia (the defining abnormality)
- Insulin also drives renal Na and water retention -> fluid overload, pulmonary oedema, cardiac decompensation
- Thiamine is consumed as a cofactor (pyruvate dehydrogenase, transketolase) -> acute Wernicke's / wet beriberi
- Nadir at 24-72 h after feeding starts - the danger window is not day 1
3 more sections, plus exam facts
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