Refeeding syndrome

(Redirected from Refeeding Syndrome)


Mostly an issue with TPN, risk of death.


When a severely malnourished patient is given glucose, the following cascade of events takes place:

  • Insulin is released
    • this stimulates drive to produce ATP
    • As ATP is produced, phosphorus is depleted
    • As ATP is produced, the cellular Na/K ATPase is activated, leading to transcellular movement of potassium and eventually other electrolytes, including magnesium, phosphorus and calcium into the cell.
    • this leads to hypokalemia, hypomagnesemia, and hypophosphatemia.
    • Metabolic acidosis also develops.
  • Electrolyte abnormalities can cause prolonged QTc
  • Rapid phosphorus depletion can lead to hemolysis, hypotension, altered mental status.

Clinical Features

Differential Diagnosis



  • CBC
  • Chemistry
  • Magnesium
  • Phosphorus
  • ECG



See Also


  1. Bhraonain, Sinead, et al. “Chronic malnutrition may in fact be an acute emergency.” The Journal of Emergency Medicine, 2013, Vol 44, issue 1, pages 72-74
  2. Bjelakovic, Goran, et al. “Antioxidant Supplements for prevention of mortality in healthy participants and patients with various diseases.” Sao Paula Med J 2015; 133(2):164-165.


Ross Donaldson