ICU Cases · GI & nutrition
Hot case — the bedside: the refeeding syndrome
A CICM hot case on the refeeding syndrome — the hypophosphataemia, the hypokalaemia, the hypomagnesaemia, the arrhythmia risk, and the management (the slow escalation, the thiamine, the electrolyte replacement).
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Prompt
At the bedside of a malnourished patient started on enteral nutrition 2 days ago, whose phosphate has fallen to 0.4. Assess and manage.
Presentation
You are called to the bedside of a 60-year-old man who was malnourished on admission (the BMI of 17, the albumin of 25) and was started on the full-rate enteral nutrition 2 days ago. His phosphate has fallen from 0.9 to 0.4 mmol/L, the potassium is 3.1, and the nurse reports the palpitations.[1]
References2ShowHide
- [1]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [2]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.