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HomeEating DisorderRefeeding Syndrome: What You Ought to Know

Refeeding Syndrome: What You Ought to Know

Refeeding syndrome generally happens when somebody who’s malnourished, probably because the results of an consuming dysfunction, begins to eat extra commonly once more.

Sadly, the situation can turn into fairly severe. Complicated metabolic processes that happen when somebody begins consuming extra commonly may end up in problems corresponding to coronary heart failure, respiratory failure, electrolyte imbalances, and even dying.

That’s one motive why anybody present process the refeeding course of ought to work with a crew of medical professionals. With correct care and precaution, it’s doable to stop refeeding syndrome, and assist severely malnourished sufferers turn into stronger and more healthy once more, and proceed on the trail to restoration.

What’s Refeeding Syndrome?

Refeeding syndrome is a severe well being situation that happens when somebody who has been malnourished or undergone extended fasting begins to eat once more. It’s characterised by a shift within the physique’s metabolism and electrolyte steadiness.

Throughout instances of underfeeding, the physique undergoes main modifications. Disadvantaged of vitamins, it would decelerate the metabolic course of, which breaks down meals and turns it into vitality, as a way to preserve future vitality shops. The physique could even start breaking down saved fats and muscle for vitality, in absence of enough diet.

However as soon as meals begins being reintroduced, the physique should modify as soon as once more. This may be an uncomfortable and probably even harmful course of, particularly if meals is reintroduced too quickly. It additionally typically units off an inside chain of reactions, which might have a variety of penalties.

Adjustments in Electrolyte Ranges

Electrolytes are a gaggle of important minerals, which assist preserve a variety of very important features within the physique. Electrolyte imbalance can result in a variety of problems.

With refeeding syndrome, frequent electrolyte imbalances that happen embody low phosphate, potassium, and magnesium ranges. These minerals all have completely different roles within the physique, however lots of them work to assist energy the physique’s electrical impulses.

The costs set off by these electrolytes energy key processes within the mind and nervous system and assist transfer the muscle groups themselves, together with the guts. Imbalances can result in coronary heart arrhythmias, muscle weak spot, and seizures, amongst different well being dangers.

Fluid Imbalance

Electrolytes additionally play an necessary function in sustaining the physique’s inside fluid ranges. And when these are out of proportion, it could result in a variety of points.

When somebody begins refeeding after lengthy intervals of underfeeding, their physique shifts into anabolism, or, basically, the revving up of metabolism. This course of requires extra fluids to shift into the cells, which might result in an imbalance in fluid ranges.

Swelling and edema, which is a specific kind of swelling, can occur consequently. [1]

Adjustments in Acid-Base Steadiness

With a view to perform most effectively, the physique requires a sure pH degree. And a variety of inside processes commonly happen to assist steadiness acidic and alkaline compounds for optimum functioning.

When the physique begins to course of extra glucose, vitamins, and different meals elements throughout the refeeding course of, it results in a variety of inside shifts, together with not simply in metabolism, however in insulin manufacturing and thyroid ranges.

These modifications can even result in a shift within the acid-base steadiness throughout the physique. Penalties of this instability embody respiratory issues, and metabolic acidosis, through which the physique has an excessive amount of acid and inadequate base. [2]

Indicators and Signs of Refeeding Syndrome

Refeeding after a interval of underfeeding or malnutrition ought to at all times be achieved with the steering of a medical crew, as a result of severe problems that may happen.

Nonetheless, there are some indicators and signs that may assist with figuring out sufferers who could also be scuffling with refeeding syndrome.

Fluid Retention

Because of its impact on electrolytes and different bodily processes, refeeding syndrome may cause fluid retention, resulting in swelling, significantly within the legs and toes.

Individuals scuffling with the situation could expertise difficulties transferring round.


Low blood sugar (hypoglycemia) is one other frequent symptom of refeeding syndrome.

Because the physique begins to course of meals once more, it could not be capable to produce sufficient insulin to control blood sugar ranges, resulting in low blood sugar. This could trigger shakiness, sweating, confusion, and even seizures.

Respiratory Misery

Refeeding syndrome could trigger respiratory misery, resulting in shortness of breath and issue respiratory. That is related to the buildup of fluid within the lungs, which makes it troublesome for the physique to get sufficient oxygen.


Fatigue is a typical symptom of refeeding syndrome, because the physique works laborious to regulate to the brand new inflow of vitamins. It might take some time to construct up sufficient vitality to perform correctly.

Cardiac Points

Refeeding syndrome can even trigger cardiac points like cardiac arrhythmias and coronary heart failure in people with anorexia nervosa (AN). [3]

The electrolyte imbalances brought on by refeeding syndrome can have an effect on the guts’s potential to pump blood correctly, resulting in extra heart-related problems.

Brief- and Lengthy-Time period Results of Refeeding Syndrome

The sudden inflow of vitamins into the physique after intervals of underfeeding may cause numerous short-term and long-term results.

Within the brief time period, refeeding syndrome may cause:

  • Muscle weak spot
  • Cramps
  • Irregular heartbeat
  • Swelling
  • Fluid accumulation within the lungs and different organs

In the long run, refeeding syndrome can progress to trigger injury to numerous organ techniques. The center, for instance, could develop points, resulting in coronary heart failure. The liver and pancreas can also turn into broken, rising the danger of an infection and different problems.

Moreover, refeeding can even result in an elevated danger of creating anemia, or a low depend of crimson blood cells, which might include its personal spate of issues, corresponding to fatigue, weak spot, chest ache, or irregular heartbeat.

Who’s At Danger of Growing Refeeding Syndrome?

Refeeding syndrome significantly impacts individuals who have skilled lengthy bouts of underfeeding or malnourishment. This could come about for a variety of individuals, together with:

  • People with anorexia nervosa. This psychological well being situation is characterised by an intense concern of gaining weight, leading to a severely restrictive eating regimen, and sometimes resulting in underfeeding. Refeeding syndrome is taken into account a very giant danger for individuals scuffling with AN.
  • People with different consuming issuesBulimia nervosa (BN), avoidant/restrictive meals consumption dysfunction (ARFID), and different consuming issues that contain restrictive consuming patterns can even put a person in danger for the form of malnourishment that might set off refeeding syndrome.
  • People who apply long-term fasting. The act of not consuming or partaking in a really low-calorie eating regimen for an prolonged interval could put somebody in danger for refeeding syndrome, if/after they begin consuming extra once more.
  • People with a historical past of alcohol abuseAlcoholism can result in malnutrition, which is tied to an elevated danger of creating refeeding syndrome.
  • People who’ve had gastrointestinal surgical procedure. Gastrointestinal surgical procedure can disrupt the traditional absorption of vitamins, resulting in malnutrition, and, finally, refeeding syndrome.
  • People with a continual sickness. Most cancers, AIDS, continual obstructive pulmonary illness (COPD), and different sicknesses that work to lower urge for food or make it troublesome to eat can result in underfeeding, malnutrition, and an elevated danger of refeeding syndrome.
  • People who’ve had a latest sickness or harm. Any sickness or harm that leads to a lack of urge for food or decreased meals consumption can put a person in danger for refeeding syndrome.
  • Sufferers with continual malnutrition. This may be brought on by a variety of well being issues, together with marasmus, morbid weight problems with profound weight reduction, malabsorptive syndrome, inflammatory bowel illness, cystic fibrosis, and brief bowel syndrome.

Tips on how to Diagnose and Deal with Refeeding Syndrome

To diagnose refeeding syndrome, healthcare professionals will research a person’s medical historical past, together with details about their consuming habits. Moreover, you will need to contemplate any underlying situations a affected person could have which might contribute to the event of the complication.

Docs could carry out bodily exams and different diagnostic exams to verify for indicators of electrolyte or fluid imbalances. A hospital’s dietetics crew may also be concerned, to search for ranges of particular vitamins and minerals, and make sure that the suitable dietary interventions are applied.

Early detection of refeeding syndrome is essential to stop additional problems. If recognized, you will need to decelerate the feeding charge and replenish important electrolytes to stabilize the affected person’s situation.

Treating Refeeding Syndrome

Therapy for refeeding syndrome entails addressing any underlying dietary imbalances which are inflicting additional problems. This will embody supplementing the eating regimen with potassium, phosphorus, and magnesium. Fluids can also be given to assist right any fluid imbalances.

As somebody’s physique will proceed to alter and adapt as they add extra energy and vitamins to their day by day consumption, it’s important for a medical crew to proceed monitoring a affected person’s progress, and modify any remedies as wanted. The affected person also needs to have a balanced eating regimen that gives sufficient energy and vitamins to help therapeutic and restoration.

An inflow of meals after intervals of undereating can really feel uncomfortable, and set off any variety of inside reactions, however with skilled assist, it may be doable to keep away from refeeding syndrome, and work towards managing the situation and bettering total well being.

Tips on how to Scale back the Danger of Growing Refeeding Syndrome

Following a gradual and managed refeeding plan is necessary to scale back the danger of refeeding syndrome. Working with a medical crew is the easiest way to make sure this plan is monitored and adjusted as wanted, to keep away from any potential well being dangers.

Assess the Particular person’s Dietary Standing

Earlier than beginning any refeeding plan, it’s necessary to evaluate somebody’s present dietary standing. It will give docs a baseline to start out off of, and assist them perceive the interior mechanisms which will already be beginning up.

It’s not unusual for a medical crew to measure somebody’s physique weight and peak, and order blood exams to evaluate inside measurements, corresponding to electrolyte, glucose, and different nutrient ranges.

Begin with a Low-Calorie Eating regimen

Whereas there’s some scientific debate about the easiest way to provoke a refeeding schedule, many agree {that a} refeeding plan ought to begin with a low-calorie eating regimen.

An early emphasis is on offering important vitamins corresponding to protein, nutritional vitamins, and minerals. This will imply offering a eating regimen that’s excessive in fruits, greens, and lean protein sources, corresponding to fish.

Monitor Electrolyte Ranges

Electrolyte imbalances, significantly low potassium, magnesium, and phosphorus ranges, are a typical complication of refeeding syndrome. It’s necessary to observe electrolyte ranges intently all through the refeeding course of.

If a health care provider, nutritionist, or different member of the medical crew notices ranges starting to alter, they need to hold a detailed watch on this progress, and modify any refeeding diets accordingly.

Therapy support

Present Psychological Assist

Undernutrition is commonly related to poor entry to meals and poverty, whereas the kind of underfeeding and malnutrition related to consuming issues is often linked to different psychological well being situations.

Offering psychological help for somebody present process refeeding will help handle these underlying points, which might work to enhance their total sense of well-being, and their possibilities of sustained restoration.

Discovering Assist for an Consuming Dysfunction

When you or a cherished one are scuffling with undernutrition as a result of an consuming dysfunction, it’s a good suggestion to search assist.

You can begin by talking along with your doctor, or with a psychological well being therapist. These medical professionals could possibly level you within the course of extra info, higher assets, and the kind of packages that may assist.

If you’re experiencing undernutrition for any motive, you will need to search medical assist. Making an attempt to regain weight by yourself can result in harmful imbalances within the physique, which might trigger a variety of severe problems.

Nonetheless, the necessary factor to recollect is that assistance is at all times accessible. With the correct of steering and help, it’s doable to securely regain diet and embark on the street to restoration.


  1. Shrimanker, I., Bhattarai, S. (2022). Electrolytes. StatPearls. Retrieved January 25, 2023.
  2. Singla, M., Perry, A., & Lavery, E. (2012). Refeeding syndrome as an uncommon reason behind anion hole metabolic acidosisNavy drugs; 177(11):1393–1395.
  3. Kohn, M. R., Golden, N. H., & Shenker, I. R. (1998). Cardiac arrest and delirium: displays of the refeeding syndrome in severely malnourished adolescents with anorexia nervosaThe Journal of Adolescent Well being; 22(3):239–243.

The opinions and views of our visitor contributors are shared to offer a broad perspective of consuming issues. These should not essentially the views of Consuming Dysfunction Hope, however an effort to supply dialogue of varied points by completely different involved people.

We at Consuming Dysfunction Hope perceive that consuming issues end result from a mixture of environmental and genetic elements. When you or a cherished one are affected by an consuming dysfunction, please know that there’s hope for you, and search quick skilled assist.

Final Up to date & Reviewed By: Jacquelyn Ekern, MS, LPC on February 22, 2023
Revealed on EatingDisorderHope.com


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