Refeeding

Definition

The process of gradually reintroducing nutrition to severely malnourished patients, done cautiously to avoid refeeding syndrome and metabolic complications. Requires careful monitoring and slow advancement.

How it works

Refeeding malnourished patients requires careful planning because rapid nutrient reintroduction causes dangerous metabolic derangements collectively known as refeeding syndrome. Severe malnutrition causes adaptive metabolic responses, including low phosphate, magnesium, and thiamine stores despite normal laboratory values. Introduction of calories shifts metabolism from catabolic to anabolic, causing sudden electrolyte shifts and complications. Initial feeding should begin at 25-50% of calculated needs with gradual advancement over 7-10 days, combined with electrolyte supplementation, thiamine, and close monitoring of phosphate, magnesium, and glucose.

Role

Safely restores nutritional status in severely malnourished patients while preventing potentially fatal refeeding syndrome complications.

Examples

• Anorexia nervosa recovery
• Starvation states
• Advanced cancer cachexia
• Post-trauma severe malnutrition

Recommendations

Start at 25-50% of estimated needs and advance by 25% every 2-3 days. Repleted electrolytes (phosphate, magnesium, potassium) before and during refeeding. Supplement thiamine 100 mg daily. Monitor electrolytes, glucose, and fluid status closely. Use enteral route preferentially when gastrointestinal function permits.

Key takeaway

Slow, monitored refeeding with electrolyte supplementation is essential to prevent life-threatening refeeding syndrome complications.

Related terms