Mehanna et al outlined a management strategy for a patient at risk for developing the refeeding syndrome. This is based on a NICE (National Institute for Health and Clinical Excellence) guideline. The authors are from University Hospital Coventry and the Heart of England Foundation Trust.


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



(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.


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