Refeeding Syndrome

An adolescent with severe dietary restriction can appear haemodynamically quiet before nutrition, then develop weakness, oedema, or a rhythm change after feeding begins. That timing matters: the immediate threat may be a metabolic shift exposed by nutrition, not simply progression of the eating disorder. Refeeding syndrome can follow anorexia nervosa, but it is not confined to eating disorders. Prolonged fasting, chronic alcohol-related malnutrition, malabsorption, post-bariatric states, oncology, critical illness, and any prolonged period of little or no intake can create the same vulnerability. A higher body weight or a serum electrolyte level that is initially within range does not exclude depleted total-body stores. Separate three clinical decisions: 1. Is the patient medically unstable now? Stabilisation and hospital-level care take priority over an outpatient eating-disorder plan. 2. Is the patient at high risk before nutrition is increased? Risk assessment should include the depth and duration of nutritional depletion, recent weight loss, gastrointestinal losses, alcohol use, and baseline electrolytes; it should not rely on BMI alone. 3. Has a post-feeding biochemical or clinical syndrome developed? A new electrolyte fall with weakness, respiratory...