Refeeding syndrome describes the metabolic abnormalities which occur on feeding a person following a period of starvation. The metabolic consequences include:

• Hypophosphataemia
• Hypokalaemia
• Hypomagnesaemia
• Abnormal fluid balance

These abnormalities can lead to organ failure.

Re-feeding problems

If patient not eaten for > 5 days, aim to re-feed at < 50% energy and protein levels

High risk for re-feeding problems

If one or more of the following:

• BMI < 16 kg/m
• Unintentional weight loss >15% over 3-6 months
• Little nutritional intake > 10 days
• Hypokalaemia, Hypophosphataemia or hypomagnesaemia prior to feeding (unless high)

If two or more of the following:

• BMI < 18.5 kg/m
• Unintentional weight loss > 10% over 3-6 months
• Little nutritional intake > 5 days