Refeeding syndrome, or feeding after starvation

[Sherry]

Caught it on the FML this morning, so checked it out. Have any of you had to deal with this? Here's the wiki desc. concerning people, but it would be the same for ferrets, I'd imagine:

en.wikipedia.org/wiki/Refeeding_syndrome

[Deleted]

Very interesting. It occurs when carbs are introduced after a period of starvation. I've never heard of it before, but it definitely should be something people are aware of, especially those who feed kibble.

Thanks for the info!

[Sherry]

I'm thinking of ones on here who have taken in little ones, barely more than skin and bones. That's when a pure raw diet seems to be too rich for them, and has to be introduced more slowly. Same for the higher end kibbles.
What I found really interesting is they said not to allow any free feeding for at least a week after reintroducing food, even if the starvation has been "moderate", or 48 hours in length.

[Deleted]

If it is only caused by carbohydrates, then would pure raw be an issue? If so, than wouldn't only kibble fed ferrets be at risk since there are no carbs in raw?

[Deleted]

I'm familiar with this from when I used to rehab wildlife. Severely emaciated animals must be slowly introduced back to eating food. I don't think it necessarily has to do with carbs, but it's the drastic shift in the body metabolism as it goes from a catabolic to anabolic state, when the animal can suddenly once again derive energy from food instead of consuming the fat (or muscles) of it's own body. It can be fatal.

Shelter operators should also be familiar with this, since they sometimes take in emaciated animals.

[Deleted]

I see. Most of what I read stated that it had to to with carbohydrates Carnivores derive their glucose from amino acids in proteins, so I assume the same pathway occurs. Protein -> amino acids -> glucose -> increase insulin -> causes potassium, phosphate, and magnesium to shift from the blood into tissue cells, leaving dangerously low blood level

However, I would expect the refeeding syndrome to be much worse for those feeding carbohydrates, because it would cause the insulin to spike faster and more severely.

[Sherry]

How many of us would supplement with kibbles, though, if we took in a wee one in this state- knowing that straight raw would be too rich for their tummies.

[Deleted]

What I meant was that you don't have to feed carbs in order to induce refeeding syndrome in an emaciated animal. Simply giving too much (what would be normal meals for a healthy animal) and too rich food (the regular diet for the particular species, including an all carnivorous diet) can lead to this syndrome.

You're right that the main mechanism is the induced higher levels of insulin followed by a rapid uptake of electrolytes from the blood into the cells. A starving animal will typically have very low intracellular levels of electrolytes (in order to sustain normal serum levels), but as the animal starts to eat again, the cells suddenly need lots of electrolytes in order to sustain the anabolic metabolism. And I agree, any type of nutrition that creates even higher levels of insulin, such as carbs, is a bad idea.

[Sherry]

How do you handle this type of problem then, Marie? As in if we take in an obviously very malnourished ferret? I know that problems come up as a result of even raw soup. Simply keep the amounts lowered, and push something like a plain pedialyte?

[Deleted]

What about cooked foods like chicken, turkey, etc? Can those be used instead, or would the same issue arise??

[Deleted]

Always start with fluids, electrolytes but no sugars. No sugars is particularly important if you give parenteral fluids. Then add to that very small meals, some animals do better with liquid meals before you give solid foods, otherwise it's simply much smaller amounts of the regular food. Keep carbs at a minimum. Increase the size of the meals very gradually over the course of 4-5 days (or more) depending on the situation. Severe cases might need to be monitored by a vet in order to correct electrolyte imbalances.

[Sherry]

Thanks Marie I think we need to sticky this one, so we don't lose it!

[Deleted]

definitly! Thankyou!!!