ReFeedSyndrom

ReFeedSyndrom, commonly called refeeding syndrome, is a potentially life-threatening metabolic disturbance that occurs when nutrition is reintroduced after prolonged undernutrition or starvation. It involves shifts in fluids and electrolytes—most notably hypophosphatemia—along with hypokalemia, hypomagnesemia, and often thiamine deficiency, which can lead to organ dysfunction.

Pathophysiology: refeeding increases insulin, driving phosphate, potassium, and magnesium into cells for anabolic processes and raising carbohydrate metabolism demands. Phosphate depletion impairs ATP production; thiamine stores may be exhausted, risking deficiency during increased glucose utilization.

Risk factors and timing: people with severe malnutrition, anorexia nervosa, chronic alcoholism, cancer cachexia, bariatric surgery, prolonged fasting, or significant recent weight loss are at risk. Refeeding syndrome typically develops within 2–7 days of starting nutrition and can present with edema, tachycardia, hypotension, weakness, confusion, seizures, or respiratory failure.

Diagnosis: clinical suspicion in at-risk patients starting refeeding; laboratory findings include hypophosphatemia, hypokalemia, hypomagnesemia, and low thiamine.

Prevention and management: identify at-risk individuals before refeeding; start nutrition at a very low caloric level (for example 5–10 kcal/kg/day in severe malnutrition) and increase gradually while monitoring electrolytes daily. Provide thiamine supplementation before and during the first days (commonly 100–300 mg/day). Correct electrolyte abnormalities promptly (phosphate, potassium, magnesium) and manage complications supportively.

Prognosis: with prevention and timely treatment, outcomes are favorable; untreated refeeding syndrome can be fatal.