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Refeeding syndrome: relevance for the critically ill patient

Boot, Rianne; Koekkoek, Kristine W.A.C.; van Zanten, Arthur R.H.

Current Opinion in Critical Care: August 2018 - Volume 24 - Issue 4 - p 235–240
doi: 10.1097/MCC.0000000000000514
METABOLIC SUPPORT: Edited by Arthur R.H. van Zanten

Purpose of review To provide an overview of recent findings concerning refeeding syndrome (RFS) among critically ill patients and recommendations for daily practice.

Recent findings Recent literature shows that RFS is common among critically ill ventilated patients. Usual risk factors for non-ICU patients addressed on ICU admission do not identify patients developing RFS. A marked drop of phosphate levels (>0.16 mmol/l) from normal levels within 72 h of commencement of feeding, selects patients that benefit from hypocaloric or restricted caloric intake for at least 48 h resulting in lower long-term mortality.

Summary RFS is a potentially life-threatening condition induced by initiation of feeding after a period of starvation. Although a uniform definition is lacking, most definitions comprise a complex constellation of laboratory markers (i.e. hypophosphatemia, hypokalemia, hypomagnesemia) or clinical symptoms, including cardiac and pulmonary failure. Recent studies show that low caloric intake results in lower mortality rates in critically ill RFS patients compared with RFS patients on full nutritional support. Therefore, standard monitoring of RFS-markers (especially serum phosphate) and caloric restriction when RFS is diagnosed should be considered. Furthermore, standard therapy with thiamin and electrolyte supplementation is essential.

Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands

Correspondence to Arthur R.H. van Zanten, MD, PhD, Internist-Intensivist, Medical Advisor Executive Team, Department of Intensive Care, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands. Tel: +31 318 43 41 15; e-mail:

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