All right, so welcome back to the Internet Book of Critical Care podcast. I'm here with Adam Thomas,

and we're going to talk about refeating syndrome. A daily occurrence in the ICU, and I have to be

100% honest about this, Josh. Most of the time I leave this to the nutritionist, which is really,

really bad, but having nutritional support on multidisciplinary rounds is huge.

But you have reminded me I need to think about this and be conscious, especially with admitting

very sick patients.

100%.

And I have to admit, I feel kind of guilty.

This is one of those chapters where I write it up and as I'm writing it, I'm like, oh man, like if I've been missing cases of this, it's just, yeah, it's probably running under the radar to a certain extent.

So a little shout out to all those nutritional support staff that are on the rounds.

We know you're doing good things.

And also possibly are like really, really sluggish initiation of two feeds could possibly be

working in our favor here. You know, like, I'm always like, start the two feeds. And then they're

like, oh, we need to start it at 10 cc's an hour. So maybe that's not the worst thing in the world.

We'll take it. Okay. So today we'll cover the basics epidemiology, the lab abnormalities and their

associated signs and symptoms that you'll see. And then how to both prevent and treat this if it rears its ugly head. So Josh, basics.

What is a refeating syndrome?

And why is it such a problem?

Physiologically, refeating syndrome occurs when someone is in a starvation state.

And while they're starving, their endogenous stores of phosphate, magnesium, and potassium get run down.

And their insulin levels drop.

And then if you give them a bunch of carbohydrates

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