What is the treatment for night sweats in patients undergoing refeeding?

Treatment of Night Sweats in Refeeding Syndrome

Night sweats during refeeding should be treated with immediate phosphate supplementation (0.3-0.6 mmol/kg/day), temporary reduction in caloric intake, and increased electrolyte monitoring. 1

Risk Assessment and Prevention

Before discussing treatment, identifying patients at risk for refeeding syndrome is crucial:

High-Risk Patients:

• BMI < 16 kg/m²
• Unintentional weight loss > 15% in 3-6 months
• Little or no nutritional intake for > 10 days
• Low baseline electrolytes (potassium, phosphate, magnesium)
• History of alcohol abuse 1

Moderate-Risk Patients:

• BMI < 18.5 kg/m²
• Unintentional weight loss > 10% in 3-6 months
• Little or no nutritional intake for > 5 days 1

Treatment Algorithm for Night Sweats in Refeeding

1. Immediate Interventions:

   • Temporarily reduce caloric intake for 48 hours 2, 1
   • Increase electrolyte replacement, particularly phosphate 1
   • Monitor electrolytes 2-3 times daily 2

2. Electrolyte Replacement:

   • Phosphate: 0.3-0.6 mmol/kg/day (primary focus)
   • Potassium: 2-4 mmol/kg/day
   • Magnesium: 0.2 mmol/kg/day IV or 0.4 mmol/kg/day orally 1

3. Caloric Adjustment:

   • Restrict energy supply for 48 hours 2
   • After 48 hours, gradually increase caloric intake 2, 1
   • For high-risk patients: restart at 5-10 kcal/kg/day
   • For moderate-risk patients: restart at 15-20 kcal/kg/day 1

4. Enhanced Monitoring:

   • Measure electrolytes (potassium, magnesium, phosphate) 2-3 times daily 2
   • Monitor blood glucose every 4 hours 2
   • Daily weight measurements
   • Vital sign assessments every 4-6 hours 1
   • Fluid balance tracking (intake/output) 1

Additional Supportive Measures

• Thiamine Supplementation: 200-300 mg daily before carbohydrate administration 1
• Multivitamin Supplementation: Continue throughout refeeding period 1
• Insulin Management: Administer insulin when glucose levels exceed 10 mmol/L 2
• Fluid Management: Restrict fluid intake initially to prevent fluid overload 1

Clinical Pearls and Pitfalls

• Night sweats are an early warning sign of refeeding syndrome and should prompt immediate evaluation 1
• Overly rapid refeeding is the most common error in management 1, 3
• Inadequate electrolyte monitoring can worsen symptoms 1
• Hypophosphatemia plays a central role in refeeding syndrome pathophysiology 3
• Careful fluid resuscitation is essential to prevent complications 3

Special Considerations

• In older and polymorbid patients, nutritional treatment and targets should be met more gradually to prevent refeeding syndrome 2
• For patients receiving enteral nutrition, the same principles apply - start low and increase gradually 2
• Nutritional treatment should continue after hospital discharge with appropriate monitoring 2

By following this algorithm, healthcare providers can effectively manage night sweats in patients undergoing refeeding while minimizing the risk of serious complications associated with refeeding syndrome.