What is Refeeding Syndrome? Symptoms, Care, and FAQs

Last Medical Review On: January 29, 2024
Updated On: Jan. 29, 2024
5 min read
Written by:

Amanda Stevens, B.S.

Medical Review by:

Dr. Po-Chang Hsu, M.D., M.S.

What is Refeeding Syndrome
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    What you will learn

    Refeeding syndrome can affect anyone who is suffering from malnourishment.

    Refeeding syndrome is manageable and preventable.

    If symptoms of refeeding have begun, treatment should be administered under the supervision of a healthcare team with expertise in nutrition and malnutrition.

    Efforts to manage refeeding syndrome will look different for everyone, but this syndrome can be overcome.

    Refeeding syndrome is a complex syndrome that is often associated with eating disorders and can lead to serious health issues. Refeeding syndrome is a dangerous condition that can occur when someone who is malnourished begins consuming more nutrients again, whether parenterally, enterally, or orally.[1]

    This syndrome can result in potentially life-threatening changes in electrolyte and fluid levels.
    It is common that those who suffer from refeeding syndrome may have already suffered from other health issues, and refeeding can add to their distress. However, the refeeding syndrome is manageable.

    When extreme shifts in metabolic or hormonal changes happen in the body, serious health issues can occur. The key indicator of refeeding syndrome is hypophosphatemia or low phosphate levels in the blood.[2]

    Still, this syndrome is complicated and may also include unusual fluid, sodium balance, shifts in fat metabolism, glucose, and protein levels, hypokalemia (a lower than typical level of potassium in the bloodstream), and thiamine deficiency (where the body does not produce enough vitamin B-1 also known as thiamine).

    Who Does Refeeding Syndrome Affect?

    Refeeding syndrome can affect anyone who has not been receiving the proper nutrients and is undernourished. This is seen when someone has not been taking in enough food, calories, or vitamins. Malnutrition can prevent your body from performing the natural ability to absorb nutrients from food. This can cause you to lose your appetite, making eating increasingly more difficult.

    According to two sets of criteria published by the National Institute for Health and Clinical Excellence (NICE), those who meet one or more of the following criteria have an elevated risk of developing refeeding syndrome.[3]

    • Low levels of magnesium, potassium, or phosphorus in the blood
    • Not consuming any or enough nutrients or food within the past 10 or more days
    • BMI (body mass index) of under 16
    • Extreme weight loss within the past 3-6 months of more than 15 percent body weight

    Some medical conditions can also cause the body to become undernourished. One common condition that can cause refeeding syndrome is anorexia nervosa due to the fact that those suffering from the disease have severely restricted intake of nutrients. Because of the shift in your body chemistry and hormones when you begin eating again, it offsets your body’s levels of nutrients and electrolytes.

    According to the second set of criteria by the Nation Institute for Health and Clinical Excellence (NICE), if a patient is suffering from anorexia nervosa, they pose a heightened risk of developing refeeding syndrome if they possess two or more of the following indicators:

    • Extreme weight loss within the past 3-6 months of more than 10 percent body weight
    • Not consuming any or enough nutrients or food within the past 5 or more days
    • BMI (body mass index) of under 18.5
    • A record of alcoholism or wrongful use of specific drugs such as insulin, diuretics, antacids, and chemotherapy drugs.

    Symptoms of Refeeding Syndrome

    Signs and symptoms of refeeding syndrome occur when food reintroduction and rehydration has begun. Because it is critical to get medical help as soon as signs are noticed, it is best to be present with the patient during refeeding for observation. If any symptoms are realized, quick medical intervention is essential to recovery.

    Some signs and symptoms of refeeding syndrome include:

    • Difficulty breathing
    • Confusion
    • Weakness and fatigue
    • Seizures
    • Irregular heartbeat
    • Nausea, abdominal pain, and vomiting
    • Muscle aches
    • Rapid weight gain caused by fluid retention

    When these symptoms are present, there is a much better chance that the patient will be able to get the medical attention they need to recover from refeeding syndrome. If the patient is suffering from anorexia nervosa, it is best to begin the refeeding process in an inpatient facility so that medical attention is close by if refeeding syndrome begins.

    How Is Refeeding Syndrome Diagnosed?

    To diagnose refeeding syndrome, the patient should begin the refeeding process under the care of a treatment team. They will know what signs and symptoms to look for that may indicate refeeding syndrome.

    During the refeeding process, your treatment team will routinely check your vital signs. If there are any issues or indicators of refeeding syndrome, they will order a blood panel to help identify deficiencies and imbalances.
    As medical providers attempt to identify symptoms of refeeding syndrome, they will be looking for imbalances and indicators in the following areas:[4]

    • Potassium, glucose, sodium, and other electrolyte levels
    • Body mass and weight
    • Urine output
    • Fluid and nutrient intake

    Catching symptoms of refeeding syndrome can help get fast help to correct the imbalances. This is essential so that there are no further complications throughout the refeeding process.

    Refeeding Syndrome Treatment and Management

    Refeeding Syndrome Treatment and Management

    To overcome the potentially fatal symptoms that refeeding syndrome can cause, it is best to be under the direct care and supervision of a refeeding treatment team. When the refeeding process begins, your healthcare team will administer nutrients and electrolytes at a slow and steady pace, giving your body plenty of time to absorb the nutrients.

    If they are administered too quickly, symptoms of refeeding syndrome can begin to present, and it’s critical to catch them immediately.

    Your healthcare team will ensure that there are no vitamin deficiencies or electrolyte imbalances prior to beginning the refeeding process. If there seem to be some of those imbalances present they will administer supplements to correct these imbalances.

    Every case of malnutrition is different, and each person will need different treatment based on the severity of their case to prevent refeeding syndrome. Your treatment team will carefully evaluate your own individual needs to ensure that you are given the correct fluid and nutritional supplements.

    From here, your treatment team will slowly provide nutrients and electrolytes as needed. If treatment is administered in the hospital, they typically start with a low caloric intake, half of the goal caloric intake, and slowly increase how many are taken in.

    Those who have additional conditions such as diabetes, cancer, or eating disorders will usually undergo different types of medication management, holistic treatments, and therapy. Refeeding syndrome can be managed and prevented, and a full recovery from malnutrition can be made. Your treatment will get you onto the road to recovery and healing.

    Long-Term Care

    Once the initial treatment for malnutrition has been completed and the patient is no longer experiencing any symptoms of refeeding syndrome, long-term care options are available. It is essential for patients to maintain a healthy weight. This can be done through the help of nutritionists and dietitians. They will guide you on how to meet your own individualized nutritional needs.

    Contacting your physician to regularly monitor your body mass and weight and address any vitamin or electrolyte deficiencies is highly recommended.

    Possible Complications with Refeeding Syndrome

    Refeeding syndrome can cause many complications. It can make your body have a harder time getting the nutrients that it needs and, in severe cases, can cause fatal or life-threatening conditions. Possible complications can lead to:

    • Coma
    • Heart Failure
    • Death

    Refeeding syndrome can be managed and treated with the proper treatment and healthcare team. Whether you are currently struggling with malnutrition or are experiencing some symptoms of refeeding syndrome, there is help available. Through an individualized plan, you can get on the road to recovery and prevent refeeding syndrome.

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    Frequently Asked Questions About Refeeding Syndrome


    What is refeeding syndrome in simple terms?


    Refeeding syndrome occurs when someone who is malnourished begins eating again, and it causes imbalances of key vitamins, minerals, and electrolytes in the body. There are many symptoms of refeeding syndrome, including:

    • Difficulty breathing
    • Confusion
    • Weakness and fatigue
    • Seizures
    • Irregular heartbeat
    • Nausea, abdominal pain, vomiting
    • Muscle aches
    • Edema caused by fluid retention

    What causes refeeding syndrome?


    Refeeding syndrome is caused when someone who is malnourished intakes food or nutrients too quickly, and their body cannot process them fast enough.


    Who is at risk of refeeding syndrome?


    The risk of developing refeeding syndrome is increased for those who have a low BMI, have lost an extreme amount of weight in the past 3-6 months, or have a history of alcoholism or eating disorders such as anorexia nervosa.


    How can refeeding syndrome be prevented?


    Refeeding syndrome can be prevented by being under the care of a healthcare team while beginning to refeed. It is critical that refeeding in a slow and steady manner.


    [1][2][3]National Center for Biotechnology Information. (n.d.). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK564513/ on May 1, 2023
    [4]Ponzo, V., Pellegrini, M., Cioffi, I., Scaglione, L., &; Bo, S. (2021, January). A narrative review. Internal and emergency medicine. The refeeding syndrome: A neglected but potentially serious condition for inpatients. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843537/ on May 1, 2023

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