Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Apr;35(2):178-195.
doi: 10.1002/ncp.10474. Epub 2020 Mar 2.

ASPEN Consensus Recommendations for Refeeding Syndrome

Joshua S V da Silva  1 , David S Seres  2 , Kim Sabino  3 , Stephen C Adams  4 , Gideon J Berdahl  5 , Sandra Wolfe Citty  6 , M Petrea Cober  7   8 , David C Evans  9 , June R Greaves  10 , Kathleen M Gura  11 , Austin Michalski  12 , Stephen Plogsted  13 , Gordon S Sacks  14 , Anne M Tucker  15 , Patricia Worthington  16 , Renee N Walker  17 , Phil Ayers  18 ; Parenteral Nutrition Safety and Clinical Practice Committees, American Society for Parenteral and Enteral Nutrition
Affiliations
Review

ASPEN Consensus Recommendations for Refeeding Syndrome

Joshua S V da Silva et al. Nutr Clin Pract. 2020 Apr.

Erratum in

Abstract

Introduction: In the spring of 2017, the American Society for Parenteral and Enteral Nutrition (ASPEN) Parenteral Nutrition Safety Committee and the Clinical Practice Committee convened an interprofessional task force to develop consensus recommendations for identifying patients with or at risk for refeeding syndrome (RS) and for avoiding and managing the condition. This report provides narrative review and consensus recommendations in hospitalized adult and pediatric populations.

Methods: Because of the variation in definitions and methods reported in the literature, a consensus process was developed. Subgroups of authors investigated specific issues through literature review. Summaries were presented to the entire group for discussion via email and teleconferences. Each section was then compiled into a master document, several revisions of which were reviewed by the committee.

Findings/recommendations: This group proposes a new clinical definition, and criteria for stratifying risk with treatment and screening strategies. The authors propose that RS diagnostic criteria be stratified as follows: a decrease in any 1, 2, or 3 of serum phosphorus, potassium, and/or magnesium levels by 10%-20% (mild), 20%-30% (moderate), or >30% and/or organ dysfunction resulting from a decrease in any of these and/or due to thiamin deficiency (severe), occurring within 5 days of reintroduction of calories.

Conclusions: These consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidance, and treatment of RS.

Keywords: consensus; magnesium; nutrition assessment; nutrition support; phosphorus; potassium; refeeding syndrome.

PubMed Disclaimer

References

    1. Stanga Z, Brunner A, Leuenberger M, et al. Nutrition in clinical practice-the refeeding syndrome: illustrative cases and guidelines for prevention and treatment. Eur J Clin Nutr. 2008;62(6):687-694.
    1. Skipper A. Refeeding syndrome or refeeding hypophosphatemia: a systematic review of cases. Nutr Clin Pract. 2012;27(1):34-40.
    1. Friedli N, Stanga Z, Sobotka L, et al. Revisiting the refeeding syndrome: Results of a systematic review. Nutrition 2017;35:151-160.
    1. Burger GCE DJ, Sandstead HR. Malnutrition and Starvation in Western Netherlands September 1944-July 1945. Part I. Part II: appendices. JAMA. 1950;142(11):857-858.
    1. Brozek J CC, Keys A. DRastic food restriction: effect on cardiovascular dynamics in normotensive and hypertensive conditions. JAMA. 1948;137(18):1569-1574.

MeSH terms

LinkOut - more resources