Refeeding syndrome: what it is, and how to prevent and treat it
Open accessAbstract
Refeeding syndrome is a well described but often forgotten condition. No randomised controlled trials of treatment have been published, although there are guidelines that use best available evidence for managing the condition. In 2006 a guideline was published by the National Institute for Health and Clinical Excellence (NICE) in England and Wales. Yet because clinicians are often not aware of the problem, refeeding syndrome still occurs.1 This review aims to raise awareness of refeeding syndrome and discuss prevention and treatment. The available literature mostly comprises weaker (level 3 and 4) evidence, including cohort studies, case series, and consensus expert opinion.2 Our article also draws attention to the NICE guidelines on nutritional support in adults, with particular reference to the new recommendations for best practice in refeeding syndrome.3 These recommendations differ in parts from—and we believe improve on—previous guidelines, such as those of the Parenteral and Enteral Nutrition Group of the British Dietetic Association (box 1).4 #### Box 1 Why use the NICE guidelines on refeeding syndrome? Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally5). These shifts result …
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Marked glycemic variability (coefficient of variation > 20%) is associated with increased mortality.
“A number of observational studies confirmed a strong association between severe hyperglycemia (> 180 mg/dl, 10 mmol/l) (355), marked glycemic variability (coefficient of variation > 20%) (356, 357), mild hypoglycemia (< 70 mg/dl, 3.9 mmol/l) (358) and increased mortality.”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [357]
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ESPEN guideline on clinical nutrition in the intensive care unit.
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.037 · Cited by 2,904 · see citing works
ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit
Singer, P., Blaser, A. R., Berger, M. M., Calder, P. C., Casaer, M., Hiesmayr, M., Mayer, K., Montejo-Gonzalez, J. C., Pichard, C., Preiser, J.-C., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.07.011 · Cited by 793 · see citing works
Doig, G. S., Simpson, F., Heighes, P. T., Bellomo, R., Chesher, D., Caterson, I. D., Reade, M. C., & Harrigan, P. W. J. (2015) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(15)00418-x · Cited by 308 · see citing works
Miele, E., Shamir, R., Aloi, M., Assa, A., Braegger, C., Bronsky, J., de Ridder, L., Escher, J. C., Hojsak, I., Kolaček, S., et al. (2018) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000001896 · Cited by 191 · see citing works
A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice
Preiser, J.-C., Arabi, Y. M., Berger, M. M., Casaer, M., McClave, S., Montejo-González, J. C., Peake, S., Reintam Blaser, A., Van den Berghe, G., van Zanten, A., et al. (2021) · Critical Care · doi:10.1186/s13054-021-03847-4 · Cited by 166 · see citing works
Olthof, L. E., Koekkoek, W. A. C. K., van Setten, C., Kars, J. C. N., van Blokland, D., & van Zanten, A. R. H. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2017.08.001 · Cited by 156 · see citing works
Arabi, Y. M., Aldawood, A. S., Al-Dorzi, H. M., Tamim, H. M., Haddad, S. H., Jones, G., McIntyre, L., Solaiman, O., Sakkijha, M. H., Sadat, M., et al. (2017) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201605-1012oc · Cited by 153 · see citing works
Comerlato, P. H., Stefani, J., & Viana, L. V. (2021) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqab218 · Cited by 20 · see citing works
- Authors
- Mehanna, H. M., Moledina, J., & Travis, J.
- Affiliations
- Heart of England NHS Foundation Trust (GB)
- University Hospital Coventry (GB)
- Corresponding author
- Mehanna, Hisham M
- ORCID
- Mehanna, Hisham M
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2008-06-26
- Volume
- 336
- Issue
- 7659
- Pages
- 1495-1498
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2440847
- OpenAlex
- W2149423094
- Cited by
- 706
- References
- 0
- Citations by year
- 2026: 39 · 2025: 38 · 2024: 55 · 2023: 42 · 2022: 45 · 2021: 53 · 2020: 57 · 2019: 47 · 2018: 57 · 2017: 38 · 2016: 45 · 2015: 32 · 2014: 31 · 2013: 24 · 2012: 27
- FWCI
- 23.22
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- refeeding syndrome, malnutrition, nutritional support, electrolyte imbalance, fluid shifts, prevention, treatment, NICE guidelines, clinical awareness, parenteral nutrition, enteral nutrition
- MeSH terms
- Fasting, Humans, Syndrome, Water-Electrolyte Imbalance, Practice Guidelines as Topic, Nutritional Support, Malnutrition
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