30th July 2023

Management

The risk of life-threatening arrhythmias means patients identified to have refeeding syndrome may require cardiac monitors. Any complications of refeeding syndrome should be appropriately managed.

Prevention is key – patients at risk of refeeding syndrome should be identified prior to nutritional replacement. Preventative measures include early thiamine supplementation, and a carefully monitored slow rate of artificial nutrition and fluid replacement, for which each hospital will have local guidelines. Regular electrolyte monitoring is required.

NICE recommends that refeeding is started at no more than 50% of energy requirements in “patients who have eaten little or nothing for more than 5 days” in order to reduce the risk of developing refeeding syndrome.