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Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished. It usually occurs within four days of starting to feed again. Patients can develop fluid and electrolyte disorders, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular and hematologic complications. Most effects result from a sudden shift from fat to carbohydrate metabolism after refeeding in combination with decreased intracellular phosphate stores. Refeeding increases the basal metabolic rate. Intracellular movement of electrolytes occurs along with a fall in the serum electrolytes including phosphate, potassium,magnesium, glucose and thiamine. Significant risks arising from refeeding syndrome include confusion, coma, convulsions and death. It can be fatal if not recognized and treated properly. It may help in its avoidance to supplement glucose and thiamine and to monitor serum electrolytes. The syndrome was first described in Japanese war prisoners after the second world war. This syndrome can occur at the beginning of treatment for anorexia nervosa when patients are reintroduced to a healthy diet.

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• DDB 11205

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