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Dr. David G. Binion presents cases of patients with various types of malnutrition and starvation symptoms. Dr. Binion also offers techniques on refeeding and how to avoid refeeding syndrome.

Educational objectives:

Upon completion of this activity, participants should be able to:

  • Recognize optimal central access to avoid thrombotic complications for longterm TPN administration
  • Recognize refeeding syndrome is associated with severe electrolyte abnormalities, including hypokalemia, hypomagnesemia, and hypophosphatemia
  • Recognize clinical indications for parenteral nutrition (PN) include short bowel syndrome, intestinal pseudo- obstruction, enteric malabsorption (i.e. acute/chronic radiation damage), enterocutaneous fistula, intestinal obstruction, inability to place an enteral access device.

Reading Resources:

  1. Winter TA et al. EUR J GASTRO & HEPAT 2000; 12(2) 191-196
  2. Sjöström L, et al.; Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery.  N Engl J Med.  2004 Dec 23;351(26):2683-93.
  3. The Merck Manual. Bariatric Surgery. Last full review/revision March 2013 by Ashish C. Sinha


Dr. Binion has financial interests with the following any entity or entities producing health care goods or services as indicated below:

  • Consultant: Abbvie, UCB Pharma
  • Grant/Research: Merck, Shire, Takeda, UCB Pharma

All presenters disclosure of relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients is listed above.  No other planners, members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.1) continuing education units (CEU) which are equivalent to 1 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 11/8/2018 | Last Modified On: 4/18/2018 | Expires: 11/8/2019

This course has been expired.