Complications Refeeding Syndrome and Underlying Mechanisms

 

Causes for complications include:

(1) hypophosphatemia

(2) hypokalemia

(3) hypomagnesemia

(4) fluid intolerance

(5) glucose intolerance

(6) muscle wasting

(7) thiamine deficiency

 

Complications seen during refeeding may include:

(1) cardiac arrhythmia: 1, 2, 3, 4

(2) congestive heart failure (CHF): 1, 4

(3) cardiomyopathy: 1, 6

(4) impaired cardiac contractility: 1, 6

(5) altered blood pressure (hypotension or hypertension): 1, 2, 3

(6) tachycardia: 3

(7) cardiac arrest: 2

(8) digoxin toxicity: 2

(9) sudden death: 1, 2, 3, 4

(10) fluid overload: 4

(11) respiratory failure or ventilator dependency: 1, 6

(12) pulmonary edema: 2

(13) carbon dioxide retention: 2, 5

(14) fits

(15) weakness: 1, 2, 3

(16) paresthesias: 1, 3

(17) altered mental status: 1, 2, 3

(18) paralysis: 1, 2

(19) ataxia: 3

(20) tremor: 3

(21) vertigo: 3

(22) tetany: 3

(23) seizures: 1, 3

(24) Wernicke’s encephalopathy: 7

(25) Korsakoff’s syndrome: 7

(26) osmotic diuresis: 5

(27) prerenal azotemia: 5

(28) decreased ability of the renal tubules to concentrate urine: 2

(29) muscle weakness: 1, 2

(30) myalgia: 1,2

(31) rhabdomyolysis: 1, 2

(32) insulin resistance: 5

(33) osteomalacia

(34) platelet dysfunction: 1

(35) hemolytic anemia: 1

(36) leukocyte dysfunction: 1

(37) altered red blood cell morphology: 1

(38) anemia (nonhemolytic): 3

(39) reduced oxygen release from hyperbaric oxygen: 1

(40) metabolic alkalosis: 2

(41) glucose intolerance: 2, 5

(42) hyperglycemia: 2, 5

(43) hypernatremia: 2, 5

(44) ketoacidosis: 2, 5

(45) metabolic acidosis: 2, 5

(46) constipation: 2, 3

(47) paralytic ileus: 2

(48) abdominal pain: 3

(49) diarrhea: 3

(50) anorexia: 3

(51) fatty liver: 5

(52) dehydration: 5

(53) hypotension: 5

 

where:

• Several items (like weakness or glucose intolerance) are present more than once.