Christopher Berlin // März 2015 Refeeding syndrome.

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Presentation transcript:

Christopher Berlin // März 2015 Refeeding syndrome

Christopher Berlin // März 2015 Patient history Baumgartner, Priska (75J) 1.Leberzirrhose unklarer Aetiologie, am ehesten NASH, Child B (9 Punkte 11/2014) - portale Hypertension mit Oesophagusvarizen und hypertensiver Gastropathie - St. n. anämisierender oberer GI-Blutung bei Fundusvarizen und Oesophagusvarizen - aszitogene Dekompensation und hepatische Encephalopathie 08/ spontan bakterielle Peritonitis 08/ akute Niereninsuffizienz, am ehesten hepatorenales Syndrom 08/ Diabetes mellitus Typ 2, insulinpflichtig 3.Arterielle Hypertonie 10/ Rezidiv Bauchwandhernie bei St. n. VHP-Netzeinlage abdominal bei inkarzierter Nabelhernie

Christopher Berlin // März 2015 Refeeding syndrome What it is: fatal shifts in fluids and electrolytes hallmark biochemical feature: HYPOPHOSPHATAEMIA, but not pathognomonic other feautures: abnormal sodium and fluid balance, glucose, protein, fat metabolism, thiamine deficiency, hypokalaemia, hypomagnesaemia  in malnourished patients receiving artificial refeeding

Christopher Berlin // März 2015 Refeeding syndrome fluids + electrolytes in malnourished patients receiving artificial nutrition

Christopher Berlin // März 2015 Refeeding syndrome starvation glucagon / fat / protein / lact. decreased renal excretion intracell. mineral depl. refeeding insulin glycogen, fat, protein synth. k +, po 4-, mg 2+, thiamine phosphate extracellular homeostasis na + / water retention

Christopher Berlin // März 2015 Clinical manifestations hypotension tc AF / VF diarrhoea muscle weakness pulmonary oedema depression respiratory failure metabolic alkalosis

Christopher Berlin // März 2015 Risk factors

Christopher Berlin // März 2015 Risk factors

Christopher Berlin // März 2015 Monitoring patients at risk of RFS

Christopher Berlin // März 2015 Refeeding regime at risk for RFS patient at risk prevention > treatment

Christopher Berlin // März 2015 Thank you for your attention