The NICE (National Institute for Health and Clinical Excellence) in England has listed criteria for identifying a patient who may be at increased risk for refeeding problems.
NOTE: The original criteria are in the form of a table. Implementation is simplified if it is handled as a score.
(1) body mass index in kilograms per square meter
(2) unintentional weight loss in percent over past 3 to 6 months
(3) duration of little or no nutritional intake in days
(4) serum electrolyte concentrations before feeding
(5) history of alcohol misuse
(6) history of drug therapy
percent unintentional weight loss =
= (unintended weight loss of past 3 to 6 months) / (baseline weight) * 100%
body mass index
>= 18.5 kg per square m
16 to 18.49
unintentional weight loss
<= 10% over past 3 to 6 months
10.1 to 15%
duration of no or little nutritional intake
none or <= 5 days
5.1 to 10 days
> 10 days
serum electrolyte concentrations before feeding
potassium, phosphate OR magnesium low
potassium, phosphate AND magnesium normal or elevated
history of drug therapy with insulin, antacids, chemotherapy or diuretics OR history of alcohol misuse
total score =
= SUM(points for all of the parameters)
• minimum score: 0
• maximum score: 9
• A patient with a score >= 2 is at increased risk for the refeeding syndrome.
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Purpose: To identify a patient who may be at risk for the refeeding syndrome based on the NICE criteria.
Objective: risk factors