{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 32, Ep 1 of 4: Refeeding, Malnutrition, and Enteral Access","html":"","width":"100%","height":180,"duration":942,"description":"Episode one of the GI Nutrition chapter builds the inpatient nutrition framework and the enteral access decisions. The organizing idea is that the labs lie and the instinct to feed faster is usually wrong. Refeeding syndrome is what happens when a starvation-adapted patient meets a carbohydrate load, so the active intervention is restraint with thiamine before glucose. Hospital malnutrition is not what a low albumin says it is, so GLIM separates the phenotypic deficit from the etiologic cause. And the route of nutrition follows the gut's functional state, with a functional gut winning every time.\n \nTopics covered\n\nRefeeding syndrome and the electrolyte shift\nThiamine before glucose and Wernicke\nNICE high-risk criteria\nRestrained calorie reintroduction\nAlbumin as an inflammatory marker\nGLIM phenotypic plus etiologic criteria\nFunctional gut and enteral access selection\nPEG techniques and complications\nTube-feed diarrhea and the medication list\n \nKey decisions\n\nRefeeding calories start at ten to twenty kilocalories per kilogram per day and advance over four to seven days, with thiamine two hundred to three hundred milligrams given before any glucose load and continued daily for five to seven days.\nAny single NICE criterion, a BMI below sixteen, weight loss above fifteen percent, more than ten days of negligible intake, or pre-feeding hypokalemia, hypophosphatemia, or hypomagnesemia, makes a patient high risk for refeeding.\nAlbumin and prealbumin are negative acute-phase reactants suppressed by IL-six and TNF-alpha, so they are excluded from GLIM criteria and should never be treated as nutrition markers in an inflamed patient.\nGLIM malnutrition requires one phenotypic criterion, weight loss, low BMI, or reduced muscle mass, plus one etiologic criterion, reduced intake or assimilation or inflammation.\nA functional gut wins, so short-term feeds under four to six weeks use nasogastric or nasojejunal tubes and longer-term feeds use percutaneous endoscopic gastrostomy....","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}