Patient selection: hospitalized patient with severe anorexia nervosa
Risk factors for the refeeding syndrome:
(1) very low percent for median body mass index (or Z-score for BMI for age and sex)
(2) minimal or no nutritional intake for >= 3 days
(3) weight loss > 15% in the past 3 months
(4) electrolyte abnormalities on admission (prior to start of refeeding)
(5) one or more significant comorbid conditions
(6) one or more acute medical conditions such as sepsis
Additional factors:
(1) refeeding diet with high carbohydrate content
(2) failure to provide adequate phosphate source
(3) failure to monitor adequately, especially when starting the refeeding process
(4) excessive and/or rapid caloric intake for clinical status
(5) failure to replace nutritional deficiencies (thiamine, vitamin C, etc)
(6) hypokalemia
