Refeeding Syndrome

Last reviewed by Dr.Mary on October 2nd, 2017.


This is a medical condition where an individual has endured a considerably long period of starvation. It could also be because an individual has a poor intake of nutritional food. When this person starts to regain their appetite and starts to eat normally they can experience severe electrolytic and metabolic disturbances. This syndrome was first diagnosed in the Japanese concentration camps American survivors during World War II when they started to fall ill after being released. Anyone is at risk of developing refeeding syndrome if they have not had negligible nutrient for more than five consecutive days. It will normally occur within four days of starting to eat normally again.

Signs and Symptoms

The symptoms of refeeding syndrome not only are associated with the imbalances of electrolytes but can also extend to causing cardiac complications and gastrointestinal disturbances. With refeeding syndrome, a person might notice swelling of their feet and hands.

General symptoms

  • Weakness
  • Inability to breathe
  • Seizures
  • Mental confusion
  • Coma
  • Paralysis
  • Respiratory depression
  • Bone problems
  • Diarrhea
  • Fluid retention
  • Weight gain that is abrupt
  • An increase in vital signs
  • Mental status impaired
  • Insulin resistance

Cardiac complication symptoms

  • Cardiac arrest that could lead to death
  • Heart failure

Gastrointestinal complication symptoms

  • Abdominal pain
  • Bloating

Causes of Refeeding syndrome

The ones that are most susceptible to get refeeding syndrome are those who have not consumed food for a long period and have sustained malnutrition as the culminating effect. They can develop refeeding syndrome when they start to have healthy, balanced eating habits. Ones that are at a high risk of developing refeeding syndrome are those who are suffering from anorexia nervosa and bulimia. When a person is fed in extreme without giving their body systems adequate time to recover and resume normalcy this is when you can have an onset of various complications, including refeeding syndrome. It can also be caused by malnutrition due to long periods of starvation.


If the person has a history of an eating disorder like bulimia nervosa or anorexia nervosa in the early stages of the syndrome their eating habits need to be monitored. It is a very critical period for those who have endured an eating disorder for a long time.

People who are at a risk for developing refeeding syndrome their nutritional support is delivered at a maximum of ten kg a day and gradually raised to full needs within seven days. If it is an extreme case, the energy intake is limited to five kg a day.

Before and during the first ten days of feeding it is important to give:

  • Two to three hundred milligrams oral thiamine each day
  • One to two strong tablets of vitamin B co strong tablets three times each day or intravenous vitamin B
  • A balanced mineral supplement and multivitamin each day

It is also important to monitor and supplement enteral, intravenous, or supplement magnesium, phosphate, and potassium intake. They should receive on average 2 to 4 kg potassium each day, 0.2 kg intravenous a day, 0.3-0.6 kg phosphate a day, or 0.4 kg oral magnesium a day.

When starting a malnourished patient eating again you should start with lower levels of food that averages between twenty-five and fifty percent of their estimated daily caloric requirements. Normally when a person is suffering from refeeding syndrome, they are given intravenous phosphate concentrations for twenty-four hours and then their phosphate levels are monitored carefully for several days. If it is necessary, more phosphate can be administered.


If your body does not get enough nutrients to process, it starts to release considerably less insulin resulting in less carbohydrate production. Your body then starts to look for other sources of fat and protein to generate energy, which the body normally gets from carbohydrates. When the source of fats and proteins are used for a long period of time the electrolyte balance shifts causing potassium, phosphorus, and calcium imbalance. Your stomach endures phases of starvation pangs and emptiness so it stagnates gradually and starts to produce fewer enzymes.

Prevention and Treatment

To treat a person suffering from refeeding syndrome you need to restore the electrolyte balance by replacing thiamine. It will also correct hypophosphatemia, which is when there is an abnormally low level of phosphate in their blood. Their clinical and biochemical diagnosis and prognosis must be continued along with constant monitoring of their condition. If refeeding syndrome is not treated properly or recognized it can become fatal. The key element in treating this syndrome is weight gain through a diet of increasing calories and nutritional rehabilitation.

The only way to prevent refeeding syndrome is awareness and spreading knowledge about this syndrome among hospital staff so they can manage the patient’s refeeding syndrome and understanding any risks of countering the syndrome. If you know of someone who has a history of an eating disorder, you should try to make them aware about refeeding syndrome.

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