The Australasian Society of Parenteral and Enteral Nutrition: Consensus statements on refeeding syndrome

Kylie Matthews-Rensch^{1

2

3}, Kirrilee Blackwood⁴, Deborah Lawlis⁵, Lina Breik⁶, Cameron McLean⁷, Truc Nguyen⁸, Sarah Phillips⁹, Kimberly Small¹⁰, Tim Stewart¹¹, Amber Thatcher¹², Leanne Venkat¹³, Emily Brodie⁹, Brydie Cleeve¹⁴, Lauren Diamond¹⁵, Mei Yuen Ng¹⁶, Anna Small¹⁷, Elizabeth Viner Smith^{18

19

12}, Varsha Asrani^{20

21}

Affiliations

¹ Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
² Eating Disorders and Nutrition Research Group, School of Medicine, Western Sydney, New South Wales, Australia.
³ School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia.
⁴ Nutrition Services, Gosford Hospital, Central Coast Local Health District, Gosford, New South Wales, Australia.
⁵ Blue Mountains Memorial ANZAC Hospital/Springwood Hospital, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia.
⁶ Home Enteral Nutrition Care, Tube Dietitian, Melbourne, Victoria, Australia.
⁷ Nutrition and Dietetics Department, St George Hospital, New South Wales, Australia.
⁸ Clinical Pharmacy Department, Middlemore Hospital, Auckland, New Zealand.
⁹ Department of Clinical Nutrition, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
¹⁰ Nutrition and Dietetics, The Maitland Hospital, Metford, New South Wales, Australia.
¹¹ Dietetics and Meal Support Services, Grampians Health, Ballarat & Deakin Rural Health, Deakin University, Melbourne, Victoria, Australia.
¹² Nutrition and Dietetics Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
¹³ Dietetics Department, Liverpool Hospital, Liverpool, New South Wales, Australia.
¹⁴ Dietetics Department, Epworth Hospital- Richmond, Melbourne, Victoria, Australia.
¹⁵ Nutrition and Dietetics Department, Royal Hobart Hospital, Tasmanian Health Service, Hobart, Tasmania, Australia.
¹⁶ Nutrition and Dietetics, Monash Health, Victoria, Australia.
¹⁷ Nutrition and Dietetics, Auckland City Hospital, Auckland, New Zealand.
¹⁸ Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
¹⁹ Intensive Care Research Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
²⁰ Department of Critical Care Medicine, Nutrition and Dietetics, Auckland City Hospital, Auckland, New Zealand.
²¹ STaR Centre, Department of Surgery, University of Auckland, Auckland, New Zealand.

PMID: 40090863
PMCID: PMC11973624
DOI: 10.1111/1747-0080.70003

Practice Guideline

The Australasian Society of Parenteral and Enteral Nutrition: Consensus statements on refeeding syndrome

Kylie Matthews-Rensch et al. Nutr Diet. 2025 Apr.

. 2025 Apr;82(2):128-142.

doi: 10.1111/1747-0080.70003. Epub 2025 Mar 16.

Authors

Affiliations

¹ Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
² Eating Disorders and Nutrition Research Group, School of Medicine, Western Sydney, New South Wales, Australia.
³ School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia.
⁴ Nutrition Services, Gosford Hospital, Central Coast Local Health District, Gosford, New South Wales, Australia.
⁵ Blue Mountains Memorial ANZAC Hospital/Springwood Hospital, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia.
⁶ Home Enteral Nutrition Care, Tube Dietitian, Melbourne, Victoria, Australia.
⁷ Nutrition and Dietetics Department, St George Hospital, New South Wales, Australia.
⁸ Clinical Pharmacy Department, Middlemore Hospital, Auckland, New Zealand.
⁹ Department of Clinical Nutrition, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
¹⁰ Nutrition and Dietetics, The Maitland Hospital, Metford, New South Wales, Australia.
¹¹ Dietetics and Meal Support Services, Grampians Health, Ballarat & Deakin Rural Health, Deakin University, Melbourne, Victoria, Australia.
¹² Nutrition and Dietetics Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
¹³ Dietetics Department, Liverpool Hospital, Liverpool, New South Wales, Australia.
¹⁴ Dietetics Department, Epworth Hospital- Richmond, Melbourne, Victoria, Australia.
¹⁵ Nutrition and Dietetics Department, Royal Hobart Hospital, Tasmanian Health Service, Hobart, Tasmania, Australia.
¹⁶ Nutrition and Dietetics, Monash Health, Victoria, Australia.
¹⁷ Nutrition and Dietetics, Auckland City Hospital, Auckland, New Zealand.
¹⁸ Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
¹⁹ Intensive Care Research Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
²⁰ Department of Critical Care Medicine, Nutrition and Dietetics, Auckland City Hospital, Auckland, New Zealand.
²¹ STaR Centre, Department of Surgery, University of Auckland, Auckland, New Zealand.

PMID: 40090863
PMCID: PMC11973624
DOI: 10.1111/1747-0080.70003

Abstract

Aims: This consensus statement document describes the recommendations of the Australasian Society of Parenteral and Enteral Nutrition regarding the identification and management of refeeding syndrome and refeeding syndrome risk.

Methods: An expert working group completed a review of the literature to develop recommendations for the consensus statements. Review of the drafted consensus statements was undertaken by highly experienced clinicians.

Results: The identification and management of refeeding syndrome requires a multidisciplinary approach. Actual refeeding syndrome is rare; however, all patients should be assessed for the risk of its development. Refeeding syndrome should only be diagnosed if the patient has had adequate nutrition intake (≥50% of estimated requirements), with electrolyte imbalances and clinical symptoms emerging after its commencement. Thiamin and multivitamin supplementation and regular electrolyte monitoring should be provided to all patients at risk of developing refeeding syndrome. There is no evidence that patients at risk of developing refeeding syndrome should be started at an initial lower enteral feeding rate than already recommended for checking tolerance to enteral feeds. Goal nutrition rates should be reached within 24-72 h for all routes of nutrition. Low electrolyte levels should be replaced as per local guidelines, with consideration given to the route of replacement.

Conclusion: These consensus statements are expected to provide guidance at a national level to improve the identification and management of refeeding syndrome and refeeding syndrome risk.

Keywords: AuSPEN; electrolyte imbalance; hypophosphataemia; inpatients; malnutrition; nutrition support; refeeding syndrome.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

1. da Silva JS, Seres DS, Sabino K, et al. ASPEN consensus recommendations for refeeding syndrome. Nutr Clin Pract. 2020;35(2):178‐195. - PubMed
1. Matthews‐Rensch K, Capra S, Palmer M. Systematic review of energy initiation rates and refeeding syndrome outcomes. Nutr Clin Prac. 2021;36(1):153‐168. - PubMed
1. National Institute for Health and Clinical Excellence . Nutrition Support in Adults; National Institute for Health and Clinical Excellence; 2006.
1. Ambrose T, De Silva A, Naghibi M, et al. Refeeding risks in patients requiring intravenous nutrition support: results of a two‐centre, prospective, double‐blind, randomised controlled trial. Clin Nutr ESPEN. 2021;41:143‐152. - PubMed
1. de Vargas CK, de Magalhães Francesconi CF. An unexpectedly high incidence of refeeding syndrome in patients with total parenteral nutrition in a reference university hospital. Clin Nutr. 2021;40(6):3702‐3707. - PubMed

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The Australasian Society of Parenteral and Enteral Nutrition: Consensus statements on refeeding syndrome

Affiliations

The Australasian Society of Parenteral and Enteral Nutrition: Consensus statements on refeeding syndrome

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources