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Table of Contents
What It Is
Symptoms
Risk Groups
Diagnosis
Inpatient Treatment
Treatment Process
Complications
Self-Care
Refeeding syndrome occurs when a person ends a period of fasting. Taking in nutrition again sets off a series of body system reactions that may cause serious or life-threatening symptoms.
When Does Refeeding Syndrome Begin?
Refeeding syndrome may start within a few days after nutrition is reintroduced after fasting ormalnutrition. It’s usually described as occurring after a “prolonged” time of not taking in any nourishment. No single agreed-upon definition of timing exists when refeeding syndrome may start.
Refeeding syndrome can begin after nourishment is reintroduced orally, through an IV (parenteral nutrition), or a feeding tube (enteral nutrition). The period of starvation causes changes in several body systems. When food is reintroduced, it sets off a series of body system reactions. This may cause serious symptoms or even be life-threatening.
What Are the Symptoms of Refeeding Syndrome?
The symptoms of refeeding syndrome are nonspecific, meaning that many different conditions could cause them.
People who care for anyone who cannot communicate their symptoms may need to watch for changes that could point to refeeding syndrome. This includes babies, older adults, or anyone else with a condition that makes it difficult to talk or understand directions (such as dementia).
Some of the symptoms and signs to watch for after starting to eat or take in nutrition are:
Emergency Symptoms
Emergency symptoms of refeeding syndrome include:
Refeeding Syndrome Lab WorkLab work is an important part of recognizing and treating refeeding syndrome. Blood tests can show if levels of glucose, vitamins, and minerals are out of balance. It’s important to watch for low levels of electrolytes (charged minerals in the blood), including:Phosphate(hypophosphatemia)Magnesium(hypomagnesemia)Potassium(hypokalemia).Urine may be checked for changes that could indicate a kidney problem.
Refeeding Syndrome Lab Work
Lab work is an important part of recognizing and treating refeeding syndrome. Blood tests can show if levels of glucose, vitamins, and minerals are out of balance. It’s important to watch for low levels of electrolytes (charged minerals in the blood), including:Phosphate(hypophosphatemia)Magnesium(hypomagnesemia)Potassium(hypokalemia).Urine may be checked for changes that could indicate a kidney problem.
Lab work is an important part of recognizing and treating refeeding syndrome. Blood tests can show if levels of glucose, vitamins, and minerals are out of balance. It’s important to watch for low levels of electrolytes (charged minerals in the blood), including:
Urine may be checked for changes that could indicate a kidney problem.
Who Is At Risk?
People may be at risk for refeeding syndrome for various reasons, including medical conditions or life stages (such as the very young or the very old).
Some of the conditions and risk factors connected to a risk of refeeding syndrome include:
Fasting and Refeeding SyndromeRefeeding syndrome is also seen in people who have had weight loss surgery (bariatric surgery) or who are restricting calories in order to lose weight. Low or no nutrition intake for as little as five days is a risk factor for refeeding syndrome.Refeeding syndrome is a preventable condition. For those who intentionally restrict calories, it is important to work with a healthcare provider to do so in a healthful way. Extreme diets, crash diets, or fad diets may put people at risk for refeeding syndrome.
Fasting and Refeeding Syndrome
Refeeding syndrome is also seen in people who have had weight loss surgery (bariatric surgery) or who are restricting calories in order to lose weight. Low or no nutrition intake for as little as five days is a risk factor for refeeding syndrome.Refeeding syndrome is a preventable condition. For those who intentionally restrict calories, it is important to work with a healthcare provider to do so in a healthful way. Extreme diets, crash diets, or fad diets may put people at risk for refeeding syndrome.
Refeeding syndrome is also seen in people who have had weight loss surgery (bariatric surgery) or who are restricting calories in order to lose weight. Low or no nutrition intake for as little as five days is a risk factor for refeeding syndrome.
Refeeding syndrome is a preventable condition. For those who intentionally restrict calories, it is important to work with a healthcare provider to do so in a healthful way. Extreme diets, crash diets, or fad diets may put people at risk for refeeding syndrome.
Refeeding Syndrome Tests
There is no one way to test for or diagnose refeeding syndrome.It might be diagnosed after a healthcare provider performs a physical exam and takes a careful history, especially of any digestive problems or changes related to eating and nutrition.
Refeeding syndrome causes many changes in the body that can be measured through vital signs (such as pulse and blood pressure) and blood tests. It can also cause electrolyte imbalances or liver problems (among other body system changes).
Tests for refeeding syndrome may include:
Recommendations for Refeeding SyndromeExperts developed recommendations for refeeding syndrome.However, high-quality research is lacking, and the definition of the condition differs among healthcare providers.Because of a knowledge gap, refeeding syndrome may not be recognized when it occurs. People who live with a condition that affects eating or nutrition should be aware of the possibility that they will have symptoms and may need medical treatment.
Recommendations for Refeeding Syndrome
Experts developed recommendations for refeeding syndrome.However, high-quality research is lacking, and the definition of the condition differs among healthcare providers.Because of a knowledge gap, refeeding syndrome may not be recognized when it occurs. People who live with a condition that affects eating or nutrition should be aware of the possibility that they will have symptoms and may need medical treatment.
Experts developed recommendations for refeeding syndrome.However, high-quality research is lacking, and the definition of the condition differs among healthcare providers.
Because of a knowledge gap, refeeding syndrome may not be recognized when it occurs. People who live with a condition that affects eating or nutrition should be aware of the possibility that they will have symptoms and may need medical treatment.
Because refeeding syndrome can cause serious problems, it could be a reason for admission to a hospital. During a hospital stay, the person will be monitored closely and have their blood and vital signs tested often to watch for changes.
As food is slowly added back to the body, healthcare providers (who might be a specialized team) will keep track of vital signs and electrolyte levels. This will help avoid further symptoms or complications. The continued monitoring will also help determine how slowly nourishment needs to be added.
Treatment for refeeding syndrome may take time. Sometimes, that could mean days (between five and 10) of treatment, but in other cases, it could take weeks or even be ongoing.
Every person diagnosed with refeeding syndrome needs a specific mix of interventions to carefully add back fluids, vitamins, minerals, and calories. Treating refeeding syndrome could include the following:
Secondary Risks and Conditions
Refeeding syndrome must be recognized and treated early to avoid more complications. Some of the problems that could occur with untreated or undertreated refeeding syndrome include:
Self-Care Strategies
Treatment for refeeding syndrome will include watching for signs and symptoms at home after a diagnosis or after leaving inpatient care. Measures to avoid this problem from happening or recurring include:
How long it will take to recover fully from refeeding syndrome will vary. Those who were seriously ill may be recovering for weeks or months, especially if there were complications that have longer-lasting effects.
Summary
Refeeding syndrome disrupts body systems, which can occur when nutrition is reintroduced after fasting. It is uncommon, but it can be pretty serious. It often requires hospital treatment and close monitoring after discharge. Refeeding syndrome could be a complication of a health condition that impacts the digestive system, prolonged fasting (voluntary or involuntary), or long-term food insecurity.
Treatment includes replacing vitamins, minerals, fluids, and calories, but it is done slowly and carefully while monitoring for complications. Once at home, one must care for oneself through nutrition, hydration, and watching for changes or new symptoms.
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Reber E, Friedli N, Vasiloglou MF, Schuetz P, Stanga Z.Management of refeeding syndrome in medical inpatients.J Clin Med. 2019;8(12):2202. doi:10.3390/jcm8122202Crook MA.Refeeding syndrome: problems with definition and management.Nutrition. 2014;30(11-12):1448-1455. doi:10.1016/j.nut.2014.03.026Ward KE, Ramsay J, Vu BJ.A case of severe metabolic acidosis in the setting of a strict ketogenic diet.Cureus. 2023;15(5):e38741. doi:10.7759/cureus.38741Friedli N, Stanga Z, Sobotka L, et al.Revisiting the refeeding syndrome: results of a systematic review.Nutrition. 2017;35:151-160. doi:10.1016/j.nut.2016.05.016da Silva JSV, Seres DS, Sabino K, et al.ASPEN consensus recommendations for refeeding syndrome.Nutr Clin Pract. 2020;35(2):178-195. doi:10.1002/ncp.10474Nunes G, Guimarães M, Coelho H, et al.Prolonged fasting induces histological and ultrastructural changes in the intestinal mucosa that may reduce absorption and revert after enteral refeeding.Nutrients. 2023;16(1):128. doi:10.3390/nu16010128Additional ReadingDe Silva A, Nightingale JMD. Refeeding syndrome : physiological background and practical management. Frontline Gastroenterol. 2019;11(5):404-409. Published 2019 Dec 30. doi:10.1136/flgastro-2018-101065.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Reber E, Friedli N, Vasiloglou MF, Schuetz P, Stanga Z.Management of refeeding syndrome in medical inpatients.J Clin Med. 2019;8(12):2202. doi:10.3390/jcm8122202Crook MA.Refeeding syndrome: problems with definition and management.Nutrition. 2014;30(11-12):1448-1455. doi:10.1016/j.nut.2014.03.026Ward KE, Ramsay J, Vu BJ.A case of severe metabolic acidosis in the setting of a strict ketogenic diet.Cureus. 2023;15(5):e38741. doi:10.7759/cureus.38741Friedli N, Stanga Z, Sobotka L, et al.Revisiting the refeeding syndrome: results of a systematic review.Nutrition. 2017;35:151-160. doi:10.1016/j.nut.2016.05.016da Silva JSV, Seres DS, Sabino K, et al.ASPEN consensus recommendations for refeeding syndrome.Nutr Clin Pract. 2020;35(2):178-195. doi:10.1002/ncp.10474Nunes G, Guimarães M, Coelho H, et al.Prolonged fasting induces histological and ultrastructural changes in the intestinal mucosa that may reduce absorption and revert after enteral refeeding.Nutrients. 2023;16(1):128. doi:10.3390/nu16010128Additional ReadingDe Silva A, Nightingale JMD. Refeeding syndrome : physiological background and practical management. Frontline Gastroenterol. 2019;11(5):404-409. Published 2019 Dec 30. doi:10.1136/flgastro-2018-101065.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Reber E, Friedli N, Vasiloglou MF, Schuetz P, Stanga Z.Management of refeeding syndrome in medical inpatients.J Clin Med. 2019;8(12):2202. doi:10.3390/jcm8122202Crook MA.Refeeding syndrome: problems with definition and management.Nutrition. 2014;30(11-12):1448-1455. doi:10.1016/j.nut.2014.03.026Ward KE, Ramsay J, Vu BJ.A case of severe metabolic acidosis in the setting of a strict ketogenic diet.Cureus. 2023;15(5):e38741. doi:10.7759/cureus.38741Friedli N, Stanga Z, Sobotka L, et al.Revisiting the refeeding syndrome: results of a systematic review.Nutrition. 2017;35:151-160. doi:10.1016/j.nut.2016.05.016da Silva JSV, Seres DS, Sabino K, et al.ASPEN consensus recommendations for refeeding syndrome.Nutr Clin Pract. 2020;35(2):178-195. doi:10.1002/ncp.10474Nunes G, Guimarães M, Coelho H, et al.Prolonged fasting induces histological and ultrastructural changes in the intestinal mucosa that may reduce absorption and revert after enteral refeeding.Nutrients. 2023;16(1):128. doi:10.3390/nu16010128
Reber E, Friedli N, Vasiloglou MF, Schuetz P, Stanga Z.Management of refeeding syndrome in medical inpatients.J Clin Med. 2019;8(12):2202. doi:10.3390/jcm8122202
Crook MA.Refeeding syndrome: problems with definition and management.Nutrition. 2014;30(11-12):1448-1455. doi:10.1016/j.nut.2014.03.026
Ward KE, Ramsay J, Vu BJ.A case of severe metabolic acidosis in the setting of a strict ketogenic diet.Cureus. 2023;15(5):e38741. doi:10.7759/cureus.38741
Friedli N, Stanga Z, Sobotka L, et al.Revisiting the refeeding syndrome: results of a systematic review.Nutrition. 2017;35:151-160. doi:10.1016/j.nut.2016.05.016
da Silva JSV, Seres DS, Sabino K, et al.ASPEN consensus recommendations for refeeding syndrome.Nutr Clin Pract. 2020;35(2):178-195. doi:10.1002/ncp.10474
Nunes G, Guimarães M, Coelho H, et al.Prolonged fasting induces histological and ultrastructural changes in the intestinal mucosa that may reduce absorption and revert after enteral refeeding.Nutrients. 2023;16(1):128. doi:10.3390/nu16010128
De Silva A, Nightingale JMD. Refeeding syndrome : physiological background and practical management. Frontline Gastroenterol. 2019;11(5):404-409. Published 2019 Dec 30. doi:10.1136/flgastro-2018-101065.
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