← Chapter 11
Mental Health Nursing · Chapter 11

The Refeeding Bench

Restriction and purging kill through the heart and the electrolytes; refeeding kills through phosphate. Pick a patient and check their numbers against the medical admission criteria, then write the refeeding plan — starting rate, thiamine, lab frequency, replacement stance, advance speed — and watch five days answer you. The most dangerous day is usually the second or third, after treatment has begun and everyone has relaxed.

The patient

Your refeeding plan

Starting energy
Nutrition is started conservatively in a high-risk body and advanced on a written schedule — but a plan so cautious that it never restores weight is its own harm.
20kcal/kg/day
Thiamine
Refeeding consumes thiamine as a cofactor in carbohydrate metabolism.
Electrolyte checks
Phosphate, potassium, magnesium, calcium and glucose.
Replacement stance
Replace before the number falls, or watch the trend and act when it does?
Advancing the feed
How fast the calories climb toward the goal.
Cardiac monitoring
Bradycardia is deepest overnight.

Five days

Phosphate and potassium over five days of refeeding
Phosphate mg/dLPotassium mEq/LDanger below

Route check — what the purging did to the blood gas

The route of purging determines the acid-base picture, and this is examined constantly. Pick the pattern each route produces.
Whichever route. Potassium is the number that will stop the heart. A potassium below 3.0 mEq/L in a person who is purging, with a prolonged QT interval, is an emergency: telemetry, replacement of both potassium and magnesium — potassium will not correct while magnesium is low — review of every QT-prolonging drug, and cardiology input.