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Refeeding Syndrome & Hypoglycemia

In this episode, Dr. Kara Pepper dives into the potentially life-threatening condition known as refeeding syndrome—a serious complication that can occur when someone who has been malnourished begins eating again. This isn’t just an ICU issue—it’s especially relevant in the world of eating disorders and undernourished patients in outpatient care. Drawing from history (like post-WWII cases and the Minnesota Starvation Experiment), Kara explains the metabolic chaos that happens when food is reintroduced to a body in starvation mode: Insulin spikes trigger electrolyte shifts, fluid retention, and cardiac arrhythmias Phosphorus, potassium, and magnesium drop dangerously Patients may develop confusion, shortness of breath, nausea, weakness, and even sudden death if left unchecked She reviews the ASPEN criteria used to assess risk and explains that even patients in "normal" or larger bodies can be at risk—especially if they’ve had rapid weight loss, poor intake, or co-existing conditions like GI disease, alcohol use, or cancer. Kara also walks through: What labs to order (phosphorus is key!) When it’s safe to manage in outpatient vs. when hospitalization is needed How continuous glucose monitors (CGMs) help detect hypoglycemia in real time What real CGM data looks like in a malnourished patient The importance of dietitian support to ramp up intake slowly and safely Her final message? If you or your doctor are concerned about refeeding syndrome, there are clear ways to monitor, treat, and prevent it, but it requires awareness, proper lab monitoring, and proactive care. Learn more or schedule with Dr. Pepper at karapeppermd.com/contact Sign up for her email list for future educational content https://karapeppermd.com/#connect Suggest future topics by reaching out directly at [email protected].