Refeeding Syndrome: A Literature Review

Table 4

Refeeding regime for patients at risk of RFS [5, 29].

Day	Calorie intake (All feeding routes)	Supplements
Day 1	10 kcal/kg/day; For extreme cases; (BMI<14 kg/m^2  or no food >15 days); 5 kcal/kg/day; Carbohydrate: 50–60%; Fat: 30–40%; Protein: 15–20%	Prophylactic supplement; PO4^2−: 0.5–0.8 mmol/kg/day; K^+: 1–3 mmol/kg/day; Mg^2+: 0.3-0.4 mmmol/kg/day; Na^+: <1 mmol/kg/day (restricted); IV fluids-Restricted, maintain “zero” balance; IV Thiamine + vitamin B complex 30 minutes prior to feeding
Day 2–4	Increase by 5 kcal/kg/day; If low or no tolerance stop or keep; minimal feeding regime	Check all biochemistry and correct any abnormality; Thiamine + vitamin B complex orally or IV till day 3; Monitoring as required (Table 3)
Day 5–7	20–30 kcal/kg/day	Check electrolytes, renal and liver functions and minerals; Fluid: maintain zero balance; Consider iron supplement from day 7
Day 8–10	30 kcal/kg/day or increase to full requirement	Monitor as required (Table 3)

If RFS is suspected based on clinical and biochemical assessment or the patient develops intolerance to artificial nutritional support, the energetic intake should be reduced or stopped.
Feeding rate should be increased to meet full requirements for fluid, electrolytes, vitamins, and minerals if the patient is clinically and biochemically stable.