Patient able to tolerate Thiamine 100mg, three High strength vitamins B & C (Pabrinex®) oral or enteral therapy times daily for 10 days with injection as above. a multivitamin once daily Followed by oral thiamine 100mg three times a day until on full rate feeding. and a multivitamin once daily for a total of 10 days. Figure 3: Old Department Refeeding Guidelines Vs NICE GC32 Old Guidelines Vs NICE GC32 recommendations ST Georges Old Guidelines Does NICE recommend? Comments Determine Level of refeeding risk Yes Check calcium, phosphate, No Does not recommend to check magnesium and potassium calcium levels Start feeding at 5/10/20/ kcal/kg Yes Nil By Mouth (NBM) patients: No NICE recommends to give for 10 High potency vitamins B & C days (Pabrinex®) IV injection Give ONE pair of ampoules ONCE a day for two days. Non NBM patients: No NICE recommends prescribing: High strength vitamins B & C Vitamin B co strong 1-2 tablets (Pabrinex®) injection three times day and Thiamine Followed by oral thiamine 100mg mg daily. Prescribing IV three times a day medications when the patient can have oral medications is not cost effective. Send of for further potassium No This is impractical. NICE suggests magnesium, calcium and checking Magnesium, Potassium phosphate 6-12 after initiating and Phosphate until in normal of feeding range Follow replacement guidelines of Yes electrolyte levels are low. Dietitian will review feed rate as Not covered in NICE Implied guidelines are only for required tube feeds and not patients who eat orally
Patient able to tolerate oral or enteral therapy Thiamine 100mg, three times daily for 10 days with a multivitamin once daily until on full rate feeding. High strength vitamins B & C (Pabrinex®) injection as above. Followed by oral thiamine 100mg three times a day and a multivitamin once daily for a total of 10 days. Figure 3: Old Department Refeeding Guidelines Vs NICE GC32 Old Guidelines Vs NICE GC32 recommendations ST Georges Old Guidelines Does NICE recommend? Comments Determine Level of refeeding risk Yes Check calcium, phosphate, magnesium and potassium No Does not recommend to check calcium levels Start feeding at 5/10/20/ kcal/kg Yes Nil By Mouth (NBM) patients: High potency vitamins B & C (Pabrinex®) IV injection Give ONE pair of ampoules ONCE a day for two days. No NICE recommends to give for 10 days Non NBM patients: High strength vitamins B & C (Pabrinex®) injection Followed by oral thiamine 100mg three times a day No NICE recommends prescribing: Vitamin B co strong 1-2 tablets three times day and Thiamine mg daily. Prescribing IV medications when the patient can have oral medications is not cost effective. Send of for further potassium magnesium, calcium and phosphate 6-12 after initiating of feeding No This is impractical. NICE suggests checking Magnesium, Potassium and Phosphate until in normal range Follow replacement guidelines of electrolyte levels are low. Yes Dietitian will review feed rate as required Not covered in NICE Implied guidelines are only for tube feeds and not patients who eat orally