Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders>>>>>Calcium, Phosphate, and Magnesium
Question 8#

A 65-year-old male nursing home resident with a history of quadriplegia is admitted to the ICU for respiratory failure. He was intubated and placed on mechanical ventilation, and tube feeds were initiated on hospital day 2. Electrolyte levels are as follows on day 3. 

• Serum calcium: 7.0 mg/dL
• Serum phosphorus: 0.9 mg/dL
• Serum magnesium: 1.6 mg/dL
• Serum potassium: 3.6 mg/dL
• Serum sodium: 138 mg/dL

Besides electrolyte repletion, what should be the strategy with regard to his nutrition?

A. Stop tube feeds
B. Decrease rate of tube feeds
C. Continue same rate of tube feeds with phosphorus supplementation in feeds
D. Make no change to tube feeds rate/type

Correct Answer is B

Comment:

Correct Answer: B

The patient has refeeding syndrome. Studies suggest significant benefit in decreasing the rate of tube feed in patients who develop refeeding syndrome after initiation of tube feeds, correcting electrolyte disturbances and only then increasing back to a target rate after electrolytes have stabilized. 

Reference:

1. Doig GS, Simpson F, Heighes P, et al. Restricted versus continued standard caloric intake during the management of refeeding syndrome in critically ill adults: a randomised, parallel-group, multicentre, single-blind controlled trial. Lancet Respir Med. 2015;3(12):943-952.