Refeeding syndrome is defined as severe electrolyte and fluid shifts that occur in the early stages of nutritional replenishment when a patient’s caloric intake is suddenly increased.

If you identify a patient at risk of refeeding syndrome but the patient is NOT going to make significant dietary changes then there is a low risk of re-feeding syndrome.  

If in doubt still prescribe vitamins for re-feeding as per physical health guidelines.

Who is at risk?

  • Body mass index of <16kg/m2*
  • Weight loss of >15% in the past three to six months (e.g. 50kg patient will have lost 9kg or more)
  • Little or no nutritional intake for >10 days
  • Low levels of potassium, phosphate, or magnesium before refeeding (making dietary changes)

  • Body mass index of <18.5 kg/m2*
  • Weight loss of >10% in the past three to six months
  • Little or no nutritional intake for >5 days
  • Recent history of alcohol misuse or drugs, including insulin, chemotherapy, antacids, or diuretics

Patients at risk of re-feeding syndrome should receive a prescription of:

  • Thiamine 100mg twice a day
  • Vitamin B Co-Strong two tablets three times a day

for 10 days or until their dietary intake stabilises.

Remember patients may make have a chronic low BMI but unless they make significant dietary changes they do not need to move to the re-feeding pathway

 

For more information or advice speak to the Medic or Dietitian in your team