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What Is Refeeding Syndrome?

Medically Reviewed by Dan Brennan, MD on June 16, 2021

Getting enough nutrients is crucial to keeping your body functioning properly. If you don't eat enough food or if your body can't absorb food, you run the risk of malnutrition. You can recover from malnutrition but it might require a treatment called refeeding. With refeeding, your doctor gives you artificial nutrients to build up your body's reserves so you can recover. 

Refeeding syndrome is a life-threatening complication that can happen to people who are getting artificial nutrients due to extreme malnutrition. It is an electrolyte imbalance that can affect multiple organ systems. Without swift treatment, refeeding syndrome can result in death. 

What Is Refeeding?

When you don’t get the proper amount of food in your body, you begin to suffer from malnutrition. Recovering from severe malnutrition isn’t as simple as starting to eat normally again. You will need to be admitted to the hospital, and doctors will prescribe a special formula of artificial nutrients to replenish your body. This process is called refeeding. You’ll get the artificial nutrients by mouth or through a tube.‌

In rare cases, you might not process the artificial nutrients as expected. If this happens, you can develop a condition called refeeding syndrome. With refeeding syndrome, your body could wind up with an imbalance of electrolytes. Without the right amount of electrolyte, your organs may have trouble functioning properly.

What Causes Refeeding Syndrome?

Refeeding syndrome is a complication of treatment for malnutrition. It’s essential to replace lost nutrients because malnutrition has serious health consequences. You can develop loss of body fat and muscle wasting. It can also lead to poor bone health, anemia, or vitamin deficiencies. In children, malnutrition can cause slow growth, neurological issues, and delayed puberty because the body isn’t getting enough nutrients.‌

While refeeding can be a life-saving treatment, there's also a small risk of developing refeeding syndrome from it. Some people have metabolic changes as they process the increased nutrients. The changes can throw off the balance of electrolytes and fluids in their bodies.

Electrolytes are critical nutrients that fuel all cellular activity. Potassium, sodium, and magnesium are examples of electrolytes. You can typically get electrolytes in your diet, and they're part of refeeding formulas.‌

During refeeding, your metabolism can start to overproduce insulin, which triggers your body to synthesize protein and produce fat. The process can monopolize the electrolytes in your body. You don’t get sufficient electrolytes to your organs and this results in organ system problems.

Complications From Refeeding Syndrome

If you develop refeeding syndrome, it can affect different organ systems in your body. The effects can be life-threatening. Complications from refeeding syndrome may include:

  • Blood pressure changes
  • Bowel obstruction
  • Cardiac arrest
  • Confusion
  • Diarrhea
  • Fluid retention
  • Heart rhythm changes
  • Paralysis
  • Seizures
  • Respiratory problems

Who's at Risk for Refeeding Syndrome?

Refeeding syndrome is a complication of refeeding. You're only at risk if you have malnutrition so severe that you need artificial nutrients for it. Most refeeding patients are already in the hospital for treatment.

Your risk of malnutrition is higher if you have an underlying issue that affects the number of nutrients your body is absorbing. If you're not getting proper nutrients, you'll start to show signs of starvation. You may experience extreme weight loss, fatigue, mental fog, or other symptoms.

You might develop malnutrition if you have other conditions, including.

  • Anorexia nervosa
  • Chronic alcoholism
  • Conditions that cause malabsorption, such as inflammatory bowel disease, chronic pancreatitis, cystic fibrosis, and short bowel syndrome
  • Diet practices such as prolonged fasting or low energy diet
  • Excessive use of antacids or diuretics
  • Metabolic changes due to cancer treatment
  • Morbid obesity with extreme weight loss
  • Severe burns
  • Uncontrolled diabetes mellitus

Older adults with low nutritional reserves also run a risk of malnutrition. 

Treatment for Refeeding Syndrome

Experts believe that preventing refeeding syndrome is the most effective course of action. If you're being treated with refeeding, your doctor may monitor the electrolyte levels in your body. If there's an imbalance, your doctor will adjust the formula of nutrients to prevent refeeding syndrome.‌

If you develop refeeding syndrome, your doctor will manage any symptoms you have. Once you're stabilized, they will address the electrolyte imbalances. This should prevent a recurrence.‌

If you're undergoing refeeding treatment, talk to your doctor about your risk of refeeding syndrome.

WebMD Medical Reference

Sources

SOURCES: 

Azer S.A., Sankararaman S. Steatorrhea, StatPearls Publishing, 2021.

British Medical Journal: “Refeeding syndrome: what it is, and how to prevent and treat it.”

Canadian Society of Intestinal Research: “Refeeding Syndrome.”

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