What is Refeeding Syndrome?

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  • Written By: Amanda Barnhart
  • Edited By: Michelle Arevalo
  • Last Modified Date: 20 September 2016
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Refeeding syndrome is a condition that can occur when a person who has gone through prolonged periods of starvation or poor nutrition begins to eat again, which can result in water retention and falling levels of potassium, magnesium, and phosphorus. These symptoms can result in serious physical complications, including heart failure and even death. The condition was first observed during World War II, in prisoners of war.

Patients who have not eaten for extended periods of time, or who have been malnourished, must be monitored heavily for refeeding syndrome during the first few days after food and other forms of nutrition are reintroduced. The condition typically manifests within the first few days of treatment. People being treated for anorexia nervosa and alcoholism are also at risk for the condition.

After long periods of starvation or malnutrition, the body begins to release less insulin because there are less carbohydrates to process. The body begins to use fat and protein stored in the body to generate energy and keep the person alive. This use of protein and fat stores decreases the amount of electrolytes in the cells of the body, including phosphate.


When a starved or malnourished person is reintroduced to food or intravenous nutrition, the body begins to metabolize carbohydrates again, for energy. The pancreas secretes more insulin into the body, and phosphate levels can drop drastically, causing seizures, respiratory failure, coma, or heart failure. The reintroduction of carbohydrates also puts a strain on the respiratory system that can be fatal when combined with breathing problems resulting from phosphate levels.

The stomach begins to deteriorate after long periods of starvation and produces less digestive enzymes. Therefore, when food is reintroduced, it may be difficult for the patient to process it. Many patients experience nausea and diarrhea when they first begin to eat again, and it may take several days or weeks for the stomach to adjust to digesting food once more.

Starting a malnourished patient out with lower food levels, of between 25 and 50-percent of the person’s estimated daily caloric requirements, can help reduce the risk of refeeding syndrome. Nutrition professionals at hospitals and clinics can help monitor malnourished patients for signs of the condition before the symptoms become fatal, so that they can improve with proper treatment.

Patients who suffer from refeeding syndrome are typically given intravenous phosphate concentrations for 24 hours. After this initial period, medical professionals monitor the patient’s phosphate levels carefully for several days and administer more phosphate as needed. Other electrolyte imbalances can occur as well, and patients who have refeeding syndrome may undergo several tests to determine the amounts of electrolytes in their bloodstreams to avoid further complications.


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