Eating Disorder Service - refeeding syndrome

Contact details

Bolton Eating Disorder Service 01204 462 785

Chester Eating Disorder Service 01244 397 755

Macclesfield Eating Disorder Service 01625 505 621

Trafford Eating Disorder Service 01925 248 475

Warrington and Halton Eating Disorder Service 01925 248 475

Wirral Eating Disorder Service 0151 488 7342

This leaflet gives a brief explanation of refeeding syndrome and what can be done to prevent it.

What is refeeding syndrome?

Refeeding syndrome is defined as severe electrolyte and fluid shifts that occur in the early stages of nutritional improvement when calorie intake is suddenly increased after a period of starvation.

When/why does refeeding syndrome occur?

Refeeding syndrome can occur when nutritional intake is increased after a period of starvation. During starvation the body adapts to the lack of food available for energy and uses alternative stored sources. Levels of vitamins and minerals including Thiamine (a B vitamin) run out very quickly. When nutritional intake is increased the body switches back to using food for energy. During this shift changes occur in the body, which can result in fluid fluctuations and vitamin and mineral deficiencies e.g. phosphate and magnesium, which increases the risk of complications.

Who is at risk?

Unless significant dietary changes are made then there is low risk of refeeding syndrome. There are a number of factors that increase the risk of developing refeeding syndrome which include:

  • being underweight (BMI < 18.5 kg.m2), with risk increasing at BMI < 16.0 kg/m2
  • recent rapid weight loss
  • low levels of potassium, phosphate or magnesium
  • a history of alcohol abuse or drug use (including insulin, chemotherapy, antacids and diuretics).

How are the risks of refeeding syndrome reduced and managed?

To monitor and minimise the risk of refeeding syndrome you may be asked to:

  • attend for blood tests and other medical assessments
  • commence nutritional supplementation as prescribed
  • attend a dietetic assessment and jointly agree a suitable nutritional intake

It is important that nutritional intake is increased but not too quickly, and instead is increased in a gradual staged manner. It is therefore recommended that any dietary changes are made with appropriate guidance and support.

Medication

If you are considered to be at risk from refeeding syndrome your GP will be asked to prescribe the following:

  • Sanatogen A-Z one daily
  • Thiamin 100mg twice daily
  • Vitamin B Co Strong two tds

Remember there are many effects of starting to increase dietary intake which include bloating, swelling and discomfort. This is to be expected after a period of starvation and is not linked with refeeding syndrome.