Refeeding syndrome: an update and pragmatic approach to management

Refeeding syndrome is a potentially serious complication of starting nutritional support in patients who have had poor nutrition for more than 5 days or suffered significant unintentional weight loss over a short period of time. This clinical review aims to summarise the risk factors, pathophysiology, clinical and biochemical presentation and outline the management and prevention of refeeding syndrome. This looks at following guidelines, taking Malnutrition Universal Screening Tool (MUST) scores and providing nutrition support, as well as the role of nurses and the multidisciplinary team. Deficiencies in phosphate, magnesium, potassium and leukocytes related to refeeding syndrome are examined, with advice on their correction. Attention is also drawn to the fact that infection and sepsis are often hidden in patients who are at high risk of refeeding syndrome, and alternative signs that can point to infection in this group are outlined.