I.U.R.Khan,J.

ahmed, S Khan & J Mac fie Gastroenterology Research & Practise vol 2011

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Refeedi g y drome is well recog ised. Occurs fter a period of starvation/fasting describe of metabolic & biochemical changes

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Can causes nonimmune-mediated harm to body The physiology & pathophysiology well known, but the circumstances, clinical manifestation &

management are less clear

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Food

carbohydrate

Glucose

Energy

Gucose enter the circulation by diffusion &BSL It promote glucose uptake & storage, lipolysis & potassium cell uptake

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Starvation, level glucose

24-72 hr

Demands for glucose are met by gluconeogenesis etabolic adaptation occurs to ensure survival on fat fuel economy

The deficiencies of po,mg,k & thiamine occur to varying degrees & diff eff in diff pts

First report in 1950, obsv of malnourish prisoners of war

In 2001 crook et al.syndr of severe electrolyte & fluids assc with metab abn in malnourish pts undergoing refeeding (orally,enterally,parenterally)

Symptoms of RFS are variable, unpredicable, occur without warning & may occur late Symptoms occur cause changes in serum electrolytes in nerve, cardiac & skeletal muscle cells The biochemical abn & assc symp seen in RFS are summarized (table 1)

Principles of management are to correct biochemical abn & fluid imbalances

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Prevention is the key to successful management 3 fc fundamental : 1.early identification 2.monitoring during refeeding 3.appropriate feeding regimen Effective communication within & between teams ultidisciplinary approach

We recommend a regime ( table 4) based on current guidelines, published literature & expert opinion.

All clinician caring for vulnerable groups who might require nutritional support should recognize the risk of RFS

It is important to emphasize that RFS doesnt represent a singular condition/syndr rather it describes an illness spect within high-risk population

Improved understanding of energetic requirements in healthy & sick pts will help understanding,develop strategies to minimize RFS pts.