Definition and risk factors for refeeding syndrome in adults

da Silva, 2020National Institute for Clinical Excellence (NICE), 2006

Refeeding describes the re-introduction of nutrition after a period of fasting or very inadequate nutrition. Refeeding syndrome results from rapid shifts in fluids and electrolytes during refeeding, and is most likely to occur in the first week after starting oral, enteral or parenteral nutrition. It can be fatal in severely malnourished patients.

Adults at risk of refeeding syndrome are listed in Identifying adults at risk of refeeding syndrome.

Figure 1. Identifying adults at risk of refeeding syndrome

Patients are at high risk of developing refeeding syndrome if they have:

  • one or more of the following:
    • BMI less than 16 kg/m2
    • weight loss of greater than 15% of body weight in the last 3 to 6 months
    • little or no nutritional intake for more than 10 days
    • low concentrations of potassium, phosphate or magnesium before re-introduction of nutrition, OR
  • two or more of the following:
    • BMI less than 18.5 kg/m2
    • weight loss of greater than 10% of body weight in the last 3 to 6 months
    • little or no nutritional intake for more than 5 days
    • a history of alcohol abuse or drug use (including insulin, chemotherapy, antacids or diuretics).
Note:

BMI = body mass index

Adapted from © National Institute for Health and Care Excellence (NICE) (2012). Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. Available here. All rights reserved. Subject to Notice of rights. NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.