Patient selection: patient at risk for the refeeding syndrome
Data requirements:
(1) body weight
(2) baseline and periodic serum calcium, magnesium, phosphate and potassium concentrations
(3) severity of the malnutrition
Steps:
(1) Administer vitamins and trace elements, starting prior to refeeding:
(1a) Oral thiamine 200 to 300 mg per day.
(1b) High potency vitamin B, either intravenous or oral (1 to 2 tablets three times per day).
(1c) Oral multivitamin once per day.
(1d) Oral trace element supplement once per day.
(2) Start feeding
(2a) at 0.0209 MJ per kg per day if severely malnourished (50% of normal rate)
(2b) at 0.0418 MJ per kg per day if not severely malnourished.
(3) Slowly increase the feeding over the next 4 to 7 days.
(4) Rehydarate carefully.
(5) Provide potassium (2 to 4 mmol per kg per day).
(6) Provide oral phosphate (0.3 to 0.6 mmol per kg per day).
(7) Provide calcium.
(8) Provide magnesium (0.2 mmol per kg per day IV or 0.4 mmol per kg per day po).
(9) Monitor calcium, magnesium, phosphate, and potassium during the first 2 weeks and replace as needed.
