Refeeding Syndrome: A Consensus-Based Algorithm for Inpatients

The refeeding syndrome (RFS) is an often overlooked potential life-threatening metabolic condition. It can appear as a consequence of the refeeding of a catabolic malnourished patient. RFS is characterized by electrolyte disturbances (particularly hypophosphatemia, hypokalaemia and hypomagnesaemia) as well as by fluid dysbalance, salt retention and consecutive impaired organ function. The current evidence level for this topic is poor. A systematic literature review on risk factors, diagnostic criteria, preventive and therapeutic measures of the RFS was recently published. On that basis, an international expert group elaborated clinically relevant recommendations and developed an algorithm for the prevention, management and monitoring of the RFS in medical inpatients, which are explained in this paper. Specific criteria for the diagnosis, the risk stratification and practical suggestions for the management of nutritional therapy in patients of each risk category are proposed. The experts recommend a stepwise implementation of the energy and fluid supply as well as an electrolyte and vitamin supplementation respectively substitution. Moreover, a detailed approach of a close monitoring is demonstrated. These recommendations may help to optimize and standardize the management of at risk medical inpatients in daily practice. The focus is on daily clinical issues with medical inpatients. High quality studies will be needed to validate and further improve these recommendations.