Refeeding Syndrome (Part 2)

[@clinicalnutritionuniversity]

NEW BOOK: cnu.sellfy.store/ ALSO ON AMAZON: a.co/d/6C6lXGa ________________________________ This video was recorded at a speed to accommodate all learners. If you're a fast learner, listen at 1.25x or 1.5x by adjusting the playback speed under Settings.

[@ishathrivaithi5803]

Seriously! Wowwww. Now I feel so easy. Please make more videos on clinical Nutrition side.

[@clinicalnutritionuniversity]

Thank you! I will keep making them 🤞🏼

[@evemingle1947]

thank you, your videos are great. Are there any resources for a written protocol for initiating parenteral nutrition? looking for some help developing, but don't want to reinvent the wheel.

[@clinicalnutritionuniversity]

Hey Eve! Sorry for the delayed response here. I am not aware of any resources that serve that exact purpose, though they may exist. If you are in the U.S., I think your best best would be to browse what is available for free under Parenteral Nutrition Resources on the A.S.P.E.N. website. You could also purchase their Parenteral Nutrition Handbook, 3rd edition. Lastly, if you type 'Nassau Medical Center Parenteral Nutrition' into Google, you should be able to find a good example of what it sounds like you are looking to create. Good luck!

[@indymudshow]

Hello. Nearly 4 months ago (Aug 9th) I got covid. It hit me hard. I couldn't eat or anything for nearly 2 weeks straight. Anything I ate would make my heart race. Even when I would stand it would race. I was basically bed ridden for 2 months. The only thing I could really eat without it bothering me was boiled skinless chicken, lettuce, green beans, tomato. I'd eat that twice a day and snack on 1-2 servings of dry cornflakes to try and get vitimins I wasn't getting elsewhere. Also drank lots of water. So throughout Sept, I was getting about 400-1000 calories a day. Oct I increased to 1200-2700 and then finally was able to hit 2k+ midway through this month of November I always had weakness in my legs, etc. I've always been skinny and weighed 140 before covid and I'm currently 121 so I lost quite a bit of weight (I'm 5'9 and am 38 years old) The issue is I've been stuck eating only chicken (added ketchup) , shredded cheese, green beans, tomato and a glass of milk for months straight. To get my cals higher I increased the milk and cheese. On the 22nd I started getting very rapid heart rate and all once again (just like I did during and after covid) . I've barely been able to eat again bc my heart Will race. It's been about 6 or 7 days and I've only been able to get about 500 cals in me. I've also had to cut out the cheese and milk as now it seems my blood pressure is going up. I've had issues with heart rate my whole life and take atenolol for it. But half the time it feels like it's not working with this. I've had to cancel doc apps as I haven't been able to get up and walk around due to my hr being high. I drink lots of water and power ade from time to time. I dont know what to do or even if this syndrome is what I have.

[@jeremiasseroy1135]

How are you now (

[@jena1302]

Hi, really helpful video! - was wondering if you have any references for this information?

[@clinicalnutritionuniversity]

Hey Jen! Thanks for watching 🙌🏼 The link to the paper I used to create this video is in the video description. It is the consensus guidelines from ASPEN.

[@madelinejurek8167]

Great video! I am in my dietetic internship right now in the clinical setting. How would you recommend advancing the daily goal rate? advancing 5mL Q5 between day 1 and 2 or would advancing 10 then 15mL Q12 be more appropriate?

[@clinicalnutritionuniversity]

Great question! In most instances, I would maintain the same rate for the first 24 hours, and then if advancing is feasible, I would increase by 10-15 mL q4h on day 2

[@14latimer]

Looking for guidelines/recommendations on initiation/progression of EN when not at risk for referring syndrome. When I practiced it was standard, start at 25ml/hr progress by 25 ml q 8hr. When is it indicated to start at goal? Cant find specific guidelines from ASPEN. Can you direct me to them? On your video for calculating EN your prescription was at goal. Thanks! Love your videos.

[@clinicalnutritionuniversity]

I wouldn't start at the goal rate unless it is a non-critically ill patient who I fully expect to tolerate the feeds well. When I'm concerned about tolerance with a non-critically ill patient, I start between 30-50 mL/hr and advance by 10-15 mL/hr q4h to goal. Then for critically ill patients, I start between 10-30 mL/hr and advance the same way. For all patients, I try to be at goal within 24-48 hours. So, whatever method will safely you get there will work. It may be individualized for each patient. I'm not aware of any online resources that outline this, but I do know it's outlined in the Core Curriculum for ASPEN, which I have. If you want me to send you pictures, you can email me at [e-mail]! I can also make a video about this in the future. Thank you for bringing it to my attention.

[@danny9732]

I think I’m going thru refeeding syndrome. For the last 8 months, I’ve been eating around 300-700 calories a day. For the past week, I’ve been eating around 1k-1.4k calories a day. I feel lightheaded and dizzy every time I eat now. I went to ER and they said I was fine and not dealing with refeeding syndrome because my lactic acid levels were fine. Still, I’m worried that something bad is gonna happen. Will the dizziness go away if I just fight through it or should I slow down?

[@danny9732]

@kenai Don’t really need to go back since the sensation of dizziness went away after a week and a half of eating. It was definitely refeeding syndrome but some doctors are absolutely clueless about it. Unless you’re dying they don’t think it’s a thing. Honestly i just fought through it and it went away on its own

[@jaspal2370]

What are your thoughts on ramping up every 12 hours? Starting with 1/2 rate for 12 hours, then 75% for 12 hours, then full rate for 12 hours.

[@jeremiasseroy1135]

Consuming those foods rich in Electrolytes Components is the best way to do ?

[@sharonariyo4783]

Why did you use 30kcal unstated of the recommended 10-20

[@clinicalnutritionuniversity]

I did use the recommended 10-20 kcal/kg! I just found the goal calories first using 30 kcal/kg so I could create a plan to eventually get the patient there.

[@cipher9236]

Summary: Never go on a prolonged fasting ffs

[@BB-ux5wd]

I'm sorry ... I'm a little confused. Why would we feed someone only 10-20kcal/kg/ a day if they have a low weight? For example if someone weighed in at 78lbs or around 35kg with the equation of 10-20 kcal/kg a day would only have them eating 350-700 calories which is too low don't you think ?Don't understand ? can someone explain ?

[@clinicalnutritionuniversity]

That is just an initial energy load. It may only be for 1 or 2 days, and then it will be advanced. So, you are not feeding them at that level for very long. It is generally agreed upon that a conservative reintroduction of nutrients will prevent refeeding syndrome from occurring, or it does occur, it will be a mild case that can be treated quickly. The risks associated with an aggressive feeding approach almost certainly outweighs the risk of feeding someone a reduced level for a short amount of time.

[@BB-ux5wd]

@@clinicalnutritionuniversity I totally agree with your response 🙏🏽🌸. If my patient is 78 lbs starting out eating 480-700 calories to prevent re-feeding how do I calculate their ideal body weight to determine how many calories to give them eventually when they are out of the re- feeding syndrome danger zone ? It would be very unsafe to have them at their low weight of 78 lbs if their height is 5’4 wouldn’t it ?

[@clinicalnutritionuniversity]

@@BB-ux5wd Yes it sounds like that patient is very underweight. I do not personally use ideal body weight for patients. For underweight, anywhere from 35-40 kcal/kg actual body weight or higher may be necessary.

[@BB-ux5wd]

@@clinicalnutritionuniversity lol that’s where I feel so confused . Is it 35-40kcal/kg/ per day even when their weight increases ? Wouldn’t their calories not be consistent because if they gain weight their calories will be different each time using the 35kcal/kg/ per day . Sorry 😣 lol. I feel stumped .

[@clinicalnutritionuniversity]

@@BB-ux5wd You would be able to bring that kcal/kg range down once the patient has gained an appropriate amount of weight and you want it to stabilize, but as long as you are aiming for weight gain, it would be high. To your point though, the actual number of calories will change as the patient gains weight because you are using a different number of kilograms. That is why reassessment is important - You obtain new weights and reassess the nutritional needs.

[@edwinthomasr]

Ben Stein teaches nutritional biochem 🤣

[@mir3349]

🤣

[@clinicalnutritionuniversity]

That’s a good one! 😂

[@Houseofarrows]

…Bueller😑….