Re-feeding syndrome occurs when the severely malnourished individual begins to increase their caloric intake either voluntarily or through a feeding tube or intravenous line. In a starvation state the body usually breaks down fats and proteins into energy because carbohydrates are depleted first in starvation.

Timing for Hospitalization 2 Patients may require hospitalization if they are severely malnourished and/or have lost a great deal of weight and are at risk for refeeding syndrome. Although hospitalization can be scary, it is also a very necessary component of treatment for many people.

Inpatient hospitalization is suggested only for patients who have very low heart rates, who have a plan to commit suicide, and are less than 75% of their ideal body weight.

Symptoms of refeeding syndrome may include:

• fatigue.
• weakness.
• confusion.
• inability to breathe.
• high blood pressure.
• seizures.
• heart arrhythmias.
• heart failure.

The hallmark biochemical feature of refeeding syndrome is hypophosphataemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia.

It can take as few as 5 successive days of malnourishment for a person to be at risk of refeeding syndrome. The condition can be managed, and if doctors detect warning signs early, they may be able to prevent it. Symptoms of the syndrome usually become apparent within several days of treatment for malnourishment.

Hypophosphatemia is considered the hallmark of refeeding syndrome, although other imbalances may occur as well, including hypokalemia and hypomagnesemia.

“the risk of refeeding syndrome should be avoided through gradual increase of caloric intake and close monitoring of weight, vital signs, fluid shifts and serum electrolytes”. It, however, did not advise on how many calories to start, by how many calories to increase, nor how often to increase calories.

Refeeding syndrome is caused by rapid refeeding after a period of under-nutrition, characterised by hypophosphataemia, electrolyte shifts and has metabolic and clinical complications. High risk patients include the chronically under-nourished and those with little intake for greater than 10 days.

Some simple general rules to follow are: (1) the TEE should never exceed twice the BEE, (2) caloric intake should rarely exceed 70 to 80 kcal per kilogram of body weight or 35 to 40 kcal/lb, (3) with the severely anorectic patient, begin a diet at 20 to 25 kcal per kilogram, (4) protein intake should not exceed 1.5 to …

Remember by about one year out, there is no difference in shape between a weight-restored body and someone who has never had an eating disorder. Most people report a “redistribution” of weight within six months, although many report they begin to feel more comfortable within a few weeks.