Refeeding syndrome occurs when a previously starved patient receives an abrupt onset of full or near full caloric requirements.
Consideration of this syndrome is not infrequent in the critically ill patients in the ICU setting. Refeeding syndrome first began to get significant attention of the medical community after deaths occurred when World War II concentration camp survivors were fed by their well-meaning liberators.
Refeeding syndrome occurs 1-7 days after nutrition is started and is characterized by a massive intracellular influx of potassium and phosphorus, causing low serum levels of these components.
This can result in hemolysis, thrombocytopenia, seizures, cardiomyopathy, decreased leukocyte chemotaxis, and diaphragm dysfunction.
The astute clinician will perform close surveillance of serum values of phosphorus and potassium when a previously starved patient begins feeding. Generally, partial feeds of 10-15 kcal/kg are recommended initially.