Refeeding Syndrome

Refeeding syndrome is a series of chemical abnormalities that can occur when a person who has not had sufficient amounts of nourishment (severely malnourished) begins to be fed again.


People are at risk for refeeding syndrome if they are suddenly supplied with food or IV nutrients after a period of starvation or near-starvation. Conditions that can result in refeeding syndrome include:

  • Severe eating disorders, such as anorexia nervosa.

  • Sudden, extensive weight loss.

  • Malnutrition, including when due to cancer, heart disease, liver disease, poorly controlled diabetes, chronic obstructive pulmonary disease, or neurological conditions that interfere with normal swallowing.

  • Bowel problems that prevent the absorption of nutrients (as can happen with inflammatory bowel diseases, cystic fibrosis, chronic pancreatitis).

  • Severe neglect in children.

  • Obesity surgery.

  • Severe alcoholics.

  • Institutionalized patients.


Symptoms of refeeding syndrome may include:

  • Breathing problems.

  • Heart problems, including abnormal heart rhythms.

  • Low blood pressure.

  • Diarrhea.

  • Muscle breakdown.

  • Seizures.

  • Coma.

  • Sudden death.


Refeeding syndrome can be diagnosed through blood tests, which reveal the characteristic chemical abnormalities. Unfortunately, the diagnosis of refeeding syndrome is often delayed or missed.


Refeeding syndrome is treated by supplying deficient chemicals, such as phosphate, sodium, magnesium, or potassium. Calories should be given at a very slow rate in order to avoid refeeding syndrome. Depending on the person's condition, nutrition may be given by mouth, through an intravenous line (IV), or through a tube that goes into the patient's stomach.


  • It is important to follow your caregiver's exact directions for nutrition.

  • If you are advised to use a nutritional supplement, do so.

  • If you are asked to monitor your intake, weight, or other vital signs, be very accurate.

  • Do not change your diet without talking to your caregiver.


  • You have a fever.

  • You lose weight by accident.

  • You are unable to eat or drink.

  • You develop nausea or vomiting.

  • You develop diarrhea.

  • You faint.

  • You become disoriented or confused.

  • You have a seizure.