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Review
. 2019 Dec 13;8(12):2202.
doi: 10.3390/jcm8122202.

Management of Refeeding Syndrome in Medical Inpatients

Emilie Reber  1 , Natalie Friedli  2 , Maria F Vasiloglou  3 , Philipp Schuetz  2   4 , Zeno Stanga  1
Affiliations
Review

Management of Refeeding Syndrome in Medical Inpatients

Emilie Reber et al. J Clin Med. .

Abstract

Refeeding syndrome (RFS) is the metabolic response to the switch from starvation to a fed state in the initial phase of nutritional therapy in patients who are severely malnourished or metabolically stressed due to severe illness. It is characterized by increased serum glucose, electrolyte disturbances (particularly hypophosphatemia, hypokalemia, and hypomagnesemia), vitamin depletion (especially vitamin B1 thiamine), fluid imbalance, and salt retention, with resulting impaired organ function and cardiac arrhythmias. The awareness of the medical and nursing staff is often too low in clinical practice, leading to under-diagnosis of this complication, which often has an unspecific clinical presentation. This review provides important insights into the RFS, practical recommendations for the management of RFS in the medical inpatient population (excluding eating disorders) based on consensus opinion and on current evidence from clinical studies, including risk stratification, prevention, diagnosis, and management and monitoring of nutritional and fluid therapy.

Keywords: diagnosis; hypophosphatemia; malnutrition; management; nutritional support; nutritional therapy; refeeding syndrome.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Pathophysiology of refeeding syndrome [22]. Used by permission of the Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Prof. Dr. med. Zeno Stanga (2019).
Figure 2
Figure 2
Risk stratification for RFS, according to [19,23]. This stratification has not been validated in a clinical trial [22]. Used by permission of the Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Prof. Dr. med. Zeno Stanga (2019).
Figure 3
Figure 3
Diagnosis of RFS according to [19], and adapted from Rio et al. [28]. These diagnostic criteria have not been validated in a clinical trial [22]. Used by permission of the Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Prof. Dr. med. Zeno Stanga (2019).
Figure 4
Figure 4
Management of nutritional therapy according to the risk for RFS, after [19]. Used by permission of the Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Prof. Dr. med. Zeno Stanga (2019) [22].
Figure 5
Figure 5
Monitoring of RFS, based on [19]. Used by permission of the Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Prof. Dr. med. Zeno Stanga (2019) [22].
See this image and copyright information in PMC

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