Refeeding Syndrome in the Critically Ill: a Literature Review and Clinician’s Guide

  • C. L. McKnightEmail author
  • C. Newberry
  • M. Sarav
  • R. Martindale
  • R. Hurt
  • B. Daley
Nutrition and Obesity (S McClave, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Nutrition and Obesity


Purpose of Review

To provide an overview of current methods of diagnosis and management of refeeding syndrome in the critically ill patient population.

Recent Findings

Despite recent publications indicating refeeding syndrome (RFS) is an ongoing problem in critically ill patients, there is no standard for the diagnosis and management of this life-threatening condition. There is not a “gold standard” nutrition assessment tool for the critically ill. Currently, the National Institute for Health and Clinical Excellence criteria represent the best clinical assessment tool for RFS. Diagnosis and management with the help of a multidisciplinary metabolic team can decrease morbidity and mortality.


Although a universal definition of RFS has yet to be defined, the diagnosis is made in patients with moderate to severe malnutrition who develop electrolyte imbalance after beginning nutritional support. The imbalances potentially can lead to cardiac, pulmonary, and gastrointestinal complications and failure. Standardizing a multidisciplinary nutrition care plan and formulating a protocol for critically ill patients who develop RFS can potentially decrease complication rates and overall mortality.


Refeeding syndrome Malnutrition Hypophosphatemia Gastrointestinal Enteral Parenteral 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • C. L. McKnight
    • 1
    Email author
  • C. Newberry
    • 2
  • M. Sarav
    • 3
  • R. Martindale
    • 4
  • R. Hurt
    • 5
  • B. Daley
    • 6
  1. 1.Department of Trauma/Surgical Critical CareUniversity of Tennessee-KnoxvilleKnoxvilleUSA
  2. 2.Division of Gastroenterology & HepatologyWeill Cornell Medical CenterNew YorkUSA
  3. 3.Section of Nephrology and HypertensionNorthShore University Health Systems, University of ChicagoChicagoUSA
  4. 4.Department of General SurgeryOregon Health Science UniversityPortlandUSA
  5. 5.Division of Gastroenterology & HepatologyMayo ClinicRochesterUSA
  6. 6.Department of Trauma/Surgical Critical CareUniversity of Tennessee Graduate School of MedicineKnoxvilleUSA

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