Table 4: Refeeding regime for patients at risk of RFS [5, 29].

DayCalorie intake (All feeding routes)Supplements

Day 110 kcal/kg/day
For extreme cases
(  kg/m2  or no food 15 days)
5 kcal/kg/day
Carbohydrate: 50–60%
Fat: 30–40%
Protein: 15–20%
Prophylactic supplement
: 0.5–0.8 mmol/kg/day
: 1–3 mmol/kg/day
: 0.3-0.4 mmmol/kg/day
: 1 mmol/kg/day (restricted)
IV fluids-Restricted, maintain “zero” balance
IV Thiamine + vitamin B complex 30 minutes prior to feeding

Day 2–4Increase 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 5–720–30 kcal/kg/dayCheck electrolytes, renal and liver functions and minerals
Fluid: maintain zero balance
Consider iron supplement from day 7

Day 8–1030 kcal/kg/day or increase to full requirementMonitor 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.