What is refeeding syndrome?

Refeeding syndrome is something which can happen in response to reintroducing food after a period of being malnourished. Introducing food back into the body after a period of malnourishment can cause the level of some nutrients in the blood to drop, because they’re used up as part of the process of getting energy from the food. If the levels of these nutrients were too low to begin with, this drop can cause levels to become dangerously low. This can have serious consequences and can even be fatal.

delicious vegetable salad and golden fork and knife on table

Refeeding syndrome can occur in anyone who’s malnourished (regardless of their body size). The longer the person has gone without adequate nutrition, the higher their risk.

Other things which can increase your risk of refeeding syndrome are:

  • Being at a low weight.
  • Having lost a significant amount of weight. The more weight lost, the higher the risk.
  • Having low levels of electrolytes.

Management

Depending on someone’s risk of refeeding syndrome, the safest place for them may be in hospital, where their medical team can monitor their levels of specific nutrients in their blood and watch out for signs of refeeding syndrome. If the person’s GP feels their refeeding syndrome risk can be managed in the community, their GP will need to monitor them closely.

If you’re at risk of refeeding syndrome, taking a multivitamin and supplementing with thiamine every day from when you start refeeding will help to manage your risk. Some people will also need to supplement with phosphate, which will need to be prescribed by a GP. If you have concerns about possible interactions with any of your medications or other supplements, please discuss this with your pharmacist.

Adults and adolescents (16 years and above)

  • Adult multivitamin: 2 tablets/gummies per day
  • Thiamine: 300 mg per day (from multivitamin and B Complex eg. 2 Swisse Ultiboost Mega B tablets per day or 2 Nature’s Own Ultra B 150 Forte tablets per day)
  • Phosphate Phebra: 500 mg twice a day (if indicated)

Adolescents and children (under 16 years)

  • Children’s multivitamin: 1 tablet/gummy per day eg. Blackmores Superkids Multi Chewables
  • Thiamine: 100 mg per day – please ask your pharmacist to suggest a suitable supplement
  • Phosphate Phebra: 500 mg twice a day (if indicated)

References:

  • NSW Ministry of Health. 2018. NSW Eating Disorders Toolkit: A practice-Based Guide to the Inpatient management of Children and Adolescents with Eating Disorders.
  • WA Eating Disorders Outreach & Consultation Service (WAEDOCS). 2019. Eating Disorders: the Management of Youth and Adults – a Quick Reference Guide