The refeeding syndrome refers to a significant clinical deterioration for a severely malnourished patient who has just started to receive nutritional replacement. Although often associated with victims of war it can occur in any patient who has developed severe malnutrition.


Clinical manifestations that may appear within hours or days of starting nutritional intake by any route:

(1) heart failure

(2) hypotension

(3) cardiac arrhythmias

(4) respiratory failure

(5) rhabdomyolysis

(6) hemolytic anemia

(7) seizures

(8) coma

(9) sudden death


Underlying chemical deficiencies:

(1) marked reduction in total body phosphate stores. Serum levels may be within the normal reference range when the patient first presents, but severe hypophosphatemia (serum levels < 0.50 mmol/L) develops 2-4 days after nutrition is restarted.

(2) hypomagnesemia

(3) hypokalemia

(4) thiamine and other vitamin deficiencies

(5) protein malnutrition


The patient can die suddenly if the condition is not recognized promptly and therapy started.


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