ICU · GI & nutrition / metabolic

Refeeding Syndrome — Hypophosphataemia, Thiamine & the Low-and-Slow Refeed

Also known as Refeeding syndrome · Hypophosphataemia of refeeding · Refeeding hypophosphataemia · NICE refeeding · Thiamine deficiency · Wernicke · Malnutrition refeeding

The refeeding syndrome is the potentially fatal metabolic disturbance that occurs when the food is reintroduced too rapidly after a period of the starvation or the malnutrition. The pathophysiology: the starved state has the low insulin, the catabolism, the depleted intracellular electrolytes (the phosphate, the potassium, the magnesium) and the thiamine. On the refeeding, the insulin surge shifts the glucose, the water, and the electrolytes intracellularly, causing the precipitous falls in the serum phosphate (the hallmark), the potassium, and the magnesium, the thiamine depletion (the Wernicke), and the fluid retention (the oedema, the heart failure). The at-risk: the little or no intake over 5 days, the BMI under 16, the weight loss over 15 per cent, the alcohol misuse, the anorexia, the low baseline phosphate or potassium or magnesium. The management (NICE): the start low and slow (the 10 kcal per kg per day for the high-risk, increase over 4 to 7 days), the thiamine BEFORE the refeeding (the 200 to 300 mg), the supplement the phosphate, the potassium, the magnesium, the monitor daily. The arrhythmias are the main death cause.

Checked against its sources on 3 Sept 2026