• hypophosphataemia, hypopotassemia en hypomagnesemia,
• glucose-intolerance,
• thiamine (B1)deficienty,
• organfailure and oedema.

The refeeding syndrome can occur with parenteral as well as enteral feeding. 

High risk patients: patients with anorexia nervosa, cancer, alcoholism and some patients after operations. Also patients with neurological dysphagia who are being fed through a tube are at risk.

Recommendations for prophylaxis:

1. Be alert for the existance of the syndrome and recognise patients at risk
2. Screen and supplement phosfate and if nessecary magnesium, potassium and thiamine before restarting nutrition 
3. Start with a caloric intake < 20 kcal / kg per day
4. consult a dietician when caloric intake increases
5. Evaluate bodyweight daily in case of oedema 
6. Slowly increase the volume, monitor hartfrequency and fluidbalance
7. Monitor fosfaat, kalium, magnesium en glucose tijdens opklimfase

Advice for supplementation:

Serum-phosphate < 0.65 mmol/l: 25mmol / 24 h, iv.

Serum-phosphate < 0.4 mmol/l or a decrease of 0.2 mmol/l: 50 mmol / 24 h iv, max 10 mmol/h.

Serum-magnesium < 0.7 mmol/l: oral supplementation (unless diarrhea) magnesiumoxide or magnesiumcitrate.

Serum-magnesium <0,55 mmol/l: magnesiumsulfate, iv.

Serum-potassium < 3.5 mmol/l: oral KCl-drink or  40-80 mmol/day iv.

Vitamin B1 (thiamine) supplementation without checking the blood (takes too long and is expensive), max 50 mg/day iv of oral supplementation.

Literature:

Mehanna H., Nankivell P.C., Moledina J., Travis J. Review: refeeding syndrome-awareness, prevention and management. Head & Neck Oncology 2009 jan 26, 1: 4

©  Diëtetics, academic hospital of Maastricht march 2005