Podcast
Questions and Answers
Which of the following is a hallmark sign of refeeding syndrome?
Which of the following is a hallmark sign of refeeding syndrome?
What is a predisposing condition for refeeding syndrome?
What is a predisposing condition for refeeding syndrome?
For at-risk patients, what is the recommended approach before initiating nutrition to prevent refeeding syndrome?
For at-risk patients, what is the recommended approach before initiating nutrition to prevent refeeding syndrome?
What is a risk associated with excessive dextrose infusion in total parenteral nutrition (TPN)?
What is a risk associated with excessive dextrose infusion in total parenteral nutrition (TPN)?
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In liver complications associated with TPN, what can excessive fat accumulation in liver cells due to overfeeding lead to?
In liver complications associated with TPN, what can excessive fat accumulation in liver cells due to overfeeding lead to?
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What should be the composition of Lipids, Dextrose, and Protein in a balanced PN nutrition to help prevent hepatic steatosis?
What should be the composition of Lipids, Dextrose, and Protein in a balanced PN nutrition to help prevent hepatic steatosis?
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What is the main factor determining the risk of hyperglycemia in parenteral nutrition?
What is the main factor determining the risk of hyperglycemia in parenteral nutrition?
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In the context of parenteral nutrition, how can the risk of hyperglycemia be minimized?
In the context of parenteral nutrition, how can the risk of hyperglycemia be minimized?
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Which patient is at higher risk of hyperglycemia during parenteral nutrition?
Which patient is at higher risk of hyperglycemia during parenteral nutrition?
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What is the recommended maximum dextrose infusion rate to minimize the risk of hyperglycemia?
What is the recommended maximum dextrose infusion rate to minimize the risk of hyperglycemia?
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In a patient who has been unable to eat and has lost weight, what complication should be monitored for when initiating parenteral nutrition?
In a patient who has been unable to eat and has lost weight, what complication should be monitored for when initiating parenteral nutrition?
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Which laboratory parameter is crucial to evaluate when assessing a patient’s nutritional status?
Which laboratory parameter is crucial to evaluate when assessing a patient’s nutritional status?
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Which of the following complications is associated with hypertriglyceridemia?
Which of the following complications is associated with hypertriglyceridemia?
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What is the normal range for prealbumin levels in the body?
What is the normal range for prealbumin levels in the body?
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In non-stressed individuals, lower values of which protein are associated with malnutrition?
In non-stressed individuals, lower values of which protein are associated with malnutrition?
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When evaluating the patient's body mass index (BMI), what does a lower weight indicate?
When evaluating the patient's body mass index (BMI), what does a lower weight indicate?
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Which of the following is a potential complication of parenteral nutrition related to liver function?
Which of the following is a potential complication of parenteral nutrition related to liver function?
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What should be monitored weekly to evaluate the progress of nutrition therapy?
What should be monitored weekly to evaluate the progress of nutrition therapy?
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Study Notes
Refeeding Syndrome
- Reintroduction of nutrition after prolonged fasting or starvation can cause refeeding syndrome
- Hypophosphatemia is a hallmark sign of refeeding syndrome
- Symptoms include electrolyte abnormalities (K, Mg, P), glucose intolerance, severe fluid shifts, sodium/fluid retention, and vitamin deficiencies
- Can cause acute respiratory failure and cardiac failure
Predisposing Conditions
- Chronic starvation
- Prolonged fasting (> 10 days)
- Significant unintentional weight loss (> 15% weight loss within 3-6 months)
- BMI < 16 kg/m2
- Chronic alcoholism
- Anorexia
- Morbid obesity with massive weight loss
- Not fed for 7 to 10 days
- Malabsorption syndrome
Prevention and Treatment
- Correct baseline electrolyte abnormalities before initiating nutrition
- Advance nutritional regimen slowly (over 3-5 days)
- Include vitamin replacement in the supplementation (thiamine 100 mg; folic acid 1 mg)
Liver Complications
- Hepatic steatosis (excessive fat accumulation in liver cells)
- Cholestasis
- Cholelithiasis
Managing Hyperglycemia
- Limit dextrose infusion rate to less than 4 mg/kg/min
- Monitor blood glucose levels
- May add regular insulin (goal < 180 mg/dL)
- Start dextrose below the goal and advance as tolerated
- Allow endogenous insulin to regulate the glucose level of the body
Nutritional Assessment
- Calculate the patient's body mass index (BMI) and compare it to the average
- Evaluate the patient's albumin or prealbumin levels
- Evaluate the patient's ability to eat
- Evaluate the patient's stress factor (severity of diagnosis)
- Evaluate the patient's diet history
- Calculate ideal body weight (IBW) using the formula: IBW (female) = 45.5 + 2.3*(height over 60 inches)
Complications of Parenteral Nutrition
- Hyperglycemia
- Hypertriglyceridemia
- Refeeding syndrome
- Liver complications
- Fluid and electrolyte imbalances
- Infection and infusion-related reactions
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Description
Learn about refeeding syndrome, a potentially life-threatening condition that can occur when nutrition is reintroduced after prolonged fasting. Understand the hallmark signs, symptoms, and predisposing conditions of refeeding syndrome.
