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Refeeding in the ICU: an adult and pediatric problem

Byrnes, Matthew C; Stangenes, Jessica

Current Opinion in Clinical Nutrition & Metabolic Care: March 2011 - Volume 14 - Issue 2 - p 186–192
doi: 10.1097/MCO.0b013e328341ed93
Nutrition and the intensive care unit: Edited by Mette Berger and Jeffrey I. Mechanick

Purpose of review To describe the etiology and complications of the refeeding syndrome.

Recent findings Complications of the refeeding syndrome can include electrolyte abnormalities, heart failure, respiratory failure, and death. This syndrome is of particular importance to critically ill patients, who can be moved from the starved state to the fed state rapidly via enteral or parenteral nutrition. There are a variety of risk factors for the development of the refeeding syndrome. All of these risk factors are tied together by starvation physiology. Case reports and case series continue to be reported, suggesting that this entity continues to exist in critically ill patients. Initiation of enteral nutrition to patients with starvation physiology should be gradual and careful monitoring of electrolytes and organ function is critical during the early stages of refeeding.

Summary The refeeding syndrome remains a significant issue in critically ill patients. Knowledge of the risk factors and the clinical signs of the refeeding syndrome is important to optimize outcomes.

Division of Surgical Critical Care, University of Minnesota, Minneapolis, Minnesota, USA

Correspondence to Matthew C. Byrnes, MD, Division of Surgical Critical Care, University of Minnesota, MMC 11, 420 Delaware Street SE, Minneapolis, MN 55455, USA Tel: +1 612 625 7911; fax: +1 612 626 0439; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.