RT Journal Article SR Electronic T1 Refeeding syndrome : physiological background and practical management JF Frontline Gastroenterology JO Frontline Gastroenterol FD BMJ Publishing Group Ltd SP 404 OP 409 DO 10.1136/flgastro-2018-101065 VO 11 IS 5 A1 Aminda De Silva A1 Jeremy M D Nightingale YR 2020 UL http://fg.bmj.com/content/11/5/404.abstract AB Refeeding problems have been recognised since the the liberation of starved communities under siege. The main clinical problems may relate to hypophosphataemia, hypomagnesaemia and hypokalaemia with a risk of sudden death; thiamine deficiency with the risk of Wernike’s encephalopathy/Korsakoff psychosis and sodium/water retention. The problems are greatest with oral/enteral feeding and especially with carbohydrate due to it increasing plasma insulin and thus glucose entry into cells. It is difficult to predict patients at risk of refeeding problems so there must be a high clinical suspicion on refeeding any malnourished patient (including any who have had no or very little nutrition for over 5 days). Generous vitamin and electrolyte supplementation may be given while monitoring closely and increasing the calorie intake reasonably rapidly from 10 to 20 kcal/kg/24 hours. Often patients in this category are not hungry, but over the course of a few days, the restoration of their appetite is an indication that the risks of refeeding have been managed and it is now safe to increase the feed aiming for repletion. If problems do occur, the feed should be slowed to the previous day’s amount, reduced further or rarely stopped while fluid and electrolyte issues are corrected.