BMJ  2008;336:1495-1498 (28 June), doi:10.1136/bmj.a301

Clinical Review

Refeeding syndrome: what it is, and how to prevent and treat it

¹ Institute of Head and Neck Studies and Education, Department of Otorhinolaryngology—Head and Neck Surgery, University Hospital, Coventry CV2 2DX , ² Heart of England Foundation Trust, Birmingham, ³ Department of Otorhinolaryngology—Head and Neck Surgery, University Hospital, Coventry , ⁴ Department of Dietetics, University Hospital, Coventry

The first 150 words of the full text of this article appear below.

Refeeding syndrome is a well described but often forgotten condition. No randomised controlled trials of treatment have been published, although there are guidelines that use best available evidence for managing the condition. In 2006 a guideline was published by the National Institute for Health and Clinical Excellence (NICE) in England and Wales. Yet because clinicians are often not aware of the problem, refeeding syndrome still occurs.¹

This review aims to raise awareness of refeeding syndrome and discuss prevention and treatment. The available literature mostly comprises weaker (level 3 and 4) evidence, including cohort studies, case series, and consensus expert opinion.² Our article also draws attention to the NICE guidelines on nutritional support in adults, with particular reference to the new recommendations for best practice in refeeding syndrome.³ These recommendations differ in parts from—and we believe improve on—previous guidelines, such as those of the Parenteral and Enteral Nutrition Group of the . . . [Full text of this article]

Box 1 Why use the NICE guidelines on refeeding syndrome?

What is refeeding syndrome?

How common is refeeding syndrome?

How does refeeding syndrome develop?

Prolonged fasting
Refeeding

What electrolytes and minerals are involved in the pathogenesis?

Phosphorus
Potassium
Magnesium
Glucose
Vitamin deficiency
Sodium, nitrogen, and fluid

How can refeeding syndrome be prevented?

Box 2 Patients at high risk of refeeding syndrome ^{1 3 4}
Box 3 Criteria from the guidelines of the National Institute for Health and Clinical Excellence for identifying patients at high risk of refeeding problems (level D recommendations*)³

How can refeeding syndrome be detected and treated?

Conclusion

Summary points
Sources and selection criteria
Areas for future research

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