Management and prevention of refeeding syndrome in medical inpatients: An evidence-based and consensus-supported algorithm

Objectives:Refeeding syndrome (RFS) can be a life-threatening metabolic condition after nutritional re-plenishment if not recognized early and treated adequately. There is a lack of evidence-based treatmentand monitoring algorithm for daily clinical practice. The aim of the study was to propose an expert con-sensus guideline for RFS for the medical inpatient (not including anorexic patients) regarding risk factors,diagnostic criteria, and preventive and therapeutic measures based on a previous systematic literaturesearch.Methods:Based on a recent qualitative systematic review on the topic, we developed clinically relevantrecommendations as well as a treatment and monitoring algorithm for the clinical management of in-patients regarding RFS. With international experts, these recommendations were discussed and agreementwith the recommendation was rated.Results:Upon hospital admission, we recommend the use of specific screening criteria (i.e., low bodymass index, large unintentional weight loss, little or no nutritional intake, history of alcohol or drug abuse)for risk assessment regarding the occurrence of RFS. According to the patient’s individual risk for RFS, acareful start of nutritional therapy with a stepwise increase in energy and fluids goals and supplemen-tation of electrolyte and vitamins, as well as close clinical monitoring, is recommended. We also proposecriteria for the diagnosis of imminent and manifest RFS with practical treatment recommendations withadoption of the nutritional therapy.Conclusion:Based on the available evidence, we developed a practical algorithm for risk assessment, treat-ment, and monitoring of RFS in medical inpatients. In daily routine clinical care, this may help to optimizeand standardize the management of this vulnerable patient population. We encourage future quality studiesto further refine these recommendations.