From the Guidelines
Refeeding syndrome is most commonly related to hypophosphatemia (option c). This potentially life-threatening condition occurs when nutritional rehabilitation is initiated in severely malnourished patients. During starvation, the body depletes intracellular phosphate stores, and when refeeding begins, there is a rapid shift of phosphate into cells for ATP production and metabolic processes. This shift causes a precipitous drop in serum phosphate levels, resulting in hypophosphatemia, as noted in the ESPEN guidelines on nutrition in cancer patients 1 and the ESPEN guidelines on definitions and terminology of clinical nutrition 1.
While electrolyte abnormalities in refeeding syndrome can also include hypokalemia, hypomagnesemia, and fluid retention, hypophosphatemia is the hallmark laboratory finding and drives many of the clinical manifestations, including cardiac arrhythmias, respiratory failure, seizures, and rhabdomyolysis. The ESPEN guidelines emphasize the importance of monitoring phosphate levels, as well as other electrolytes such as potassium, phosphate, and magnesium, during the first week of nutritional rehabilitation 1.
Key points to consider in the management of refeeding syndrome include:
- Identifying at-risk patients, such as those with anorexia nervosa, chronic alcoholism, prolonged fasting, or severe weight loss
- Implementing gradual refeeding with close monitoring of electrolytes, particularly phosphate levels
- Supplying vitamin B1 and a balanced micronutrient mixture to prevent deficiencies
- Monitoring volume of circulation, fluid balance, heart rate, and rhythm, as well as clinical status, to prevent complications.
From the Research
Refeeding Syndrome
The refeeding syndrome is a condition that occurs in malnourished patients who are receiving nutritional support, and it is characterized by various metabolic complications.
Common Electrolyte Disturbances
Some of the common electrolyte disturbances associated with refeeding syndrome include:
- Hypophosphatemia: This is the most well-known and significant element of the refeeding syndrome, and it can result in serious complications such as sudden death, rhabdomyolysis, and respiratory insufficiency 2, 3, 4, 5.
- Hypokalemia: This is another electrolyte disturbance that can occur in patients with refeeding syndrome, although it is not as common as hypophosphatemia 6, 4, 5.
- Hypomagnesemia: This electrolyte disturbance can also occur in patients with refeeding syndrome, and it is often seen in combination with hypophosphatemia 6, 4, 5.
- Hyponatremia and hypocalcemia: These electrolyte disturbances can also occur in patients with refeeding syndrome, although they are less common than hypophosphatemia 5.
Relationship to Refeeding Syndrome
Based on the available evidence, hypophosphatemia is the most commonly associated electrolyte disturbance with refeeding syndrome. The correct answer is therefore (c) hypophosphatemia 2, 6, 3, 4, 5.