What Is Refeeding Syndrome? Its Symptoms, Risk Factors And Treatment

Amritha K

A metabolic disorder, refeeding syndrome occurs as a result of the reinstitution of nutrition in people who are malnourished. That is, refeeding syndrome can develop when someone who is malnourished begins to normally eat again.

Refeeding syndrome develops as a result of the reintroduction of glucose, or sugar, which can cause sudden shifts in the balance of electrolytes and fluids. This, in turn, can lead to severe complications, including death [1].

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Malnourishment, in this case, does not have to be the result of being without food for a long period, just five successive days of malnourishment can make a person be at risk of refeeding syndrome [2].

Refeeding syndrome can affect anyone and usually follows a period of malnourishment, fasting, extreme dieting, starvation and certain health conditions [3].

What Are The Complications Of Refeeding Syndrome?

Refeeding syndrome can also lead to a lack of magnesium called hypomagnesemia [11]. The symptoms of the condition include the following:

  • Weakness
  • Fatigue
  • Low calcium levels, or hypocalcemia
  • Low potassium levels, or hypokalemia
  • Nausea
  • Vomiting
  • Abnormal heart rhythms

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How Is Refeeding Syndrome Diagnosed?

The metabolic syndrome can be fatal if not recognised and treated properly. Doctors can identify people at risk for refeeding syndrome, but it is impossible to know whether a person will develop it. Therefore it is important to prevent the syndrome from developing [12].

What Is The Treatment For Refeeding Syndrome?

Research is still needed to determine the best way to treat the refeeding syndrome. Currently, treatment involves replacing essential electrolytes and slowing down the refeeding process [13].

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Replacing vitamins, such as thiamine, can also help to treat certain symptoms. Doctors may also slow the refeeding process, to help a person to adjust and recover.

Can Refeeding Syndrome Be Prevented?

As health experts assert, prevention is the most effective way to combat refeeding syndrome. However, underlying health conditions that increase the risk of refeeding syndrome aren't always preventable but the complications can be prevented by identifying individuals who are at risk, adapting refeeding programs accordingly and monitoring treatment [14].

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The best way to combat refeeding syndrome is to identify and treat at-risk people because they can recover if they receive treatment early. As doctors point out, increasing awareness and using screening programs to identify those at risk of developing refeeding syndrome is necessary.

What Causes Refeeding Syndrome?

When a person fails to eat the right amount of food, their body can quickly go into starvation mode and become malnourished. And once this continues for a period of five days, the body's ability to process food is severely compromised [4].

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As the body becomes malnourished which produces less insulin, it can prevent the production of carbohydrates. When there is an insufficiency of carbohydrates, your body uses fat reserves and stored proteins for energy and this can change the balance of electrolytes.

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So when food is reintroduced into your system, there will be a shift from fat metabolism back to carbohydrate metabolism, causing the insulin secretion to increase [5].

Refeeding syndrome can cause hypophosphatemia, a condition caused by a phosphorus deficiency and can also lead to low levels of other important electrolytes, negatively affecting your heart, lungs, kidneys, blood, muscles, digestion and the nervous system [6].

What Are The Symptoms Of Refeeding Syndrome?

Refeeding syndrome can cause sudden and fatal complications and normally develop within four days of the start of the refeeding process. And some of the common symptoms of refeeding syndrome are as follows [7]:

  • Inability to breathe
  • Fatigue
  • Seizures
  • Heart arrhythmias
  • Confusion
  • Heart failure
  • Weakness
  • High blood pressure
  • Coma
  • Death, in severe cases

Refeeding syndrome can also cause potassium levels to drop dangerously low, which can cause the following symptoms [8]:

  • Excessive urination
  • Fatigue
  • Weakness
  • Heart problems
  • Breathing problems, such as respiratory depression
  • Ileus, a blockage in the intestines

What Are The Risk Factors For Refeeding Syndrome?

One may be at the risk of developing refeeding syndrome if the have any of the following [9][10]:

  • Anorexia nervosa
  • Chronic alcohol use disorder
  • Cancer
  • Uncontrolled diabetes
  • Malnourished
  • Recently had surgery
  • Dysphagia (problem swallowing food)
  • History of using antacids or diuretics
  • BMI under 16
  • Low levels of serum phosphate, potassium, or magnesium in the blood
  • Use of certain medications, such as insulin, chemotherapy drugs

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