The process requires phosphates, magnesium and potassium which are already depleted, and the stores rapidly become used up. Formation of phosphorylated carbohydrate compounds in the liver and skeletal muscle depletes intracellular ATP and 2,3-diphosphoglycerate in red blood cells, leading to cellular dysfunction and inadequate oxygen delivery to the bodys organs. Intracellular movement of electrolytes occurs along with a fall in the serum electrolytes, including phosphate and magnesium. Levels of serum glucose may rise, and B1 vitamin thiamine may fall. Abnormal heart rhythms are the most common cause of death from refeeding syndrome, with other significant risks including confusion, coma and convulsions and cardiac failure. Clinical situations
The syndrome can occur at the beginning of treatment for anorexia nervosa when patients have an increase in calorie intake and can be fatal. It can also occur after the onset of a severe illness or major surgery. The shifting of electrolytes and fluid balance increases cardiac workload and heart rate. This can lead to acute heart failure. Oxygen consumption is increased which strains the respiratory system and can make weaning from ventilation more difficult. Diagnosis
Refeeding syndrome can be fatal if not recognized and treated properly. An awareness of the condition and a high index of suspicion are required in order to make the diagnosis. The electrolyte disturbances of the refeeding syndrome can occur within the first few days of refeeding. Close monitoring of blood biochemistry is therefore necessary in the early refeeding period.
Prevention
There are many methods of preventing or reducing industrial injuries, including anticipation of problems by risk assessment, safety training, control banding, personal protective equipment safety guards, mechanisms on machinery, and safety barriers. In addition, past problems can be analyzed to find their root causes by using a technique called root cause analysis. A 2013 Cochrane review found low-quality evidence showing that inspections, especially focused inspections, can reduce work-related injuries in the long term. See also
Occupational safety and health
Occupational disease
Occupational exposure banding
Safety culture
Work accident

References
External links
Census of Fatal Occupational Injuries Charts, 1992-2012
NIOSH Publications on Traumatic Occupational Injury Topics (2008-2009), National Institute for Occupational Safety and Health