This underinvestigated syndrome often goes unnoticed until it's too late, say Joyce Cheung and Richard Johnston
Refeeding syndrome was first reported among survivors of Japanese concentration camps in the second world war who became acutely unwell soon after their release.1 These cases followed extreme and prolonged starvation. Refeeding syndrome develops in malnourished patients who receive nutritional support after a period of inadequate intake. Malnutrition is alarmingly common among hospital inpatients. A recent meta-analysis of 18 European and North American studies, which assessed more than 10 000 inpatients, found that 31% are malnourished.2 Failure to identify patients at risk of developing refeeding syndrome, while they are being refed, results in inadequate monitoring and support of such patients. This can lead to morbidity and mortality.
Although no consensus definition exists, refeeding syndrome can be defined as the consequences of severe fluid and electrolyte shifts in malnourished patients when they are refed.3 It can develop after oral, enteral (through a tube), or parenteral (intravenous) nutritional support. The biochemical derangements