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Yet because clinicians are often not aware of the problem, refeeding syndrome still occurs.1 This review aims to raise awareness of refeeding syndrome and discuss prevention and treatment. The available literature mostly comprises weaker (level 3 and 4) evidence, including cohort studies, case series, and consensus expert opinion.2 Our article also draws attention to the NICE guidelines on nutritional support in adults, with particular reference to the new recommendations for best practice in refeeding syndrome.3 These recommendations differ in parts from—and we believe improve on—previous guidelines, such as those of the Parenteral and Enteral Nutrition Group of the British Dietetic Association (box 1).4 #### Box 1 Why use the NICE guidelines on refeeding syndrome? Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally5). These shifts result …" /> <meta name="og-title" property="og:title" content="Refeeding syndrome: what it is, and how to prevent and treat it" /> <meta name="og-url" property="og:url" content="https://www.bmj.com/content/336/7659/1495" /> <meta name="og-site-name" property="og:site_name" content="The BMJ" /> <meta name="og-description" property="og:description" content="Refeeding syndrome is a well described but often forgotten condition. No randomised controlled trials of treatment have been published, although there are guidelines that use best available evidence for managing the condition. In 2006 a guideline was published by the National Institute for Health and Clinical Excellence (NICE) in England and Wales. Yet because clinicians are often not aware of the problem, refeeding syndrome still occurs.1 This review aims to raise awareness of refeeding syndrome and discuss prevention and treatment. The available literature mostly comprises weaker (level 3 and 4) evidence, including cohort studies, case series, and consensus expert opinion.2 Our article also draws attention to the NICE guidelines on nutritional support in adults, with particular reference to the new recommendations for best practice in refeeding syndrome.3 These recommendations differ in parts from—and we believe improve on—previous guidelines, such as those of the Parenteral and Enteral Nutrition Group of the British Dietetic Association (box 1).4 #### Box 1 Why use the NICE guidelines on refeeding syndrome? Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally5). 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href="/us/education">Education</a></li> <li>Refeeding syndrome:...</li> <li class="active last">Refeeding syndrome: what it is, and how to prevent and treat it</li> </ol> <a id="main-content"></a> <div class="region region-content"> <section id="block-system-main" class="block block-system clearfix"> <div class="panel-display" > <div class="hero"> <div class="hero-wrapper"> <div class="hero-content" style="position: relative; left: 0px; top: 35.5px;"> </div>  </div>  </div>  <div class="row"> <div class="left-content col-xs-12 col-sm-8 col-md-8 col-lg-8"> <article> <div class="panel-pane pane-highwire-article-citation" > <div class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-article node566327" data-node-nid="566327" id="node-566327--21873751121" data-pisa="bmj;336/7659/1495" data-pisa-master="bmj;336/7659/1495" data-apath="/bmj/336/7659/1495.atom"><cite class='highwire-cite highwire-citation-bmj-article-top'> <span class='highwire-cite-article-type'>Clinical Review</span> <h1 class="highwire-cite-title" id="page-title">Refeeding syndrome: what it is, and how to prevent and treat it</h1> <span class='highwire-cite-journal'>BMJ</span> <span class='highwire-cite-published-year'>2008</span>; <span class='highwire-cite-volume-issue'>336</span> <span class='highwire-cite-doi'> doi: <a href="https://doi.org/10.1136/bmj.a301">https://doi.org/10.1136/bmj.a301</a></span> <span class='highwire-cite-date'>(Published 26 June 2008)</span> <span class='highwire-cite-article-as'> Cite this as: <span class="italic">BMJ</span> 2008;336:1495 </span> </cite> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs pane-panels-ajax-tab-tabs" > <div class="pane-content"> <ul class="tabs inline panels-ajax-tab"><li class="first"><a title="Article Tab - Article" href="/content/336/7659/1495" class="panels-ajax-tab-tab" data-panel-name="jnl_bmj_tab_art" 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class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="https://www.bmj.com/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-jnl_bmj_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article extract-view"><span class="highwire-journal-article-marker-start"></span><div class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">Hisham M Mehanna</span><span class="contrib-role">, consultant and honorary associate professor, and director</span><span class="xref-aff">1</span><span class="xref-aff">2</span>, </li><li class="contributor" id="contrib-2"><span class="name">Jamil Moledina</span><span class="contrib-role">, senior house officer </span><span class="xref-aff">3</span>, </li><li class="last" id="contrib-3"><span class="name">Jane Travis</span><span class="contrib-role">, Macmillan specialist dietitian</span><span class="xref-aff">4</span></li></ol><ol class="affiliation-list"><li class="aff"><address><sup>1</sup>Institute of Head and Neck Studies and Education, Department of Otorhinolaryngology—Head and Neck Surgery, University Hospital, Coventry CV2 2DX </address></li><li class="aff"><address><sup>2</sup>Heart of England Foundation Trust, Birmingham</address></li><li class="aff"><address><sup>3</sup>Department of Otorhinolaryngology—Head and Neck Surgery, University Hospital, Coventry </address></li><li class="aff"><address><sup>4</sup>Department of Dietetics, University Hospital, Coventry</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Correspondence to: H M Mehanna <span class="em-link"><span class="em-addr">Hisham.Mehanna{at}uhcw.nhs.uk</span></span></li></ol></div><p id="p-2">Refeeding syndrome is a well described but often forgotten condition. No randomised controlled trials of treatment have been published, although there are guidelines that use best available evidence for managing the condition. In 2006 a guideline was published by the National Institute for Health and Clinical Excellence (NICE) in England and Wales. Yet because clinicians are often not aware of the problem, refeeding syndrome still occurs.<span class="xref-bibr">1</span></p><p id="p-3">This review aims to raise awareness of refeeding syndrome and discuss prevention and treatment. The available literature mostly comprises weaker (level 3 and 4) evidence, including cohort studies, case series, and consensus expert opinion.<span class="xref-bibr">2</span> Our article also draws attention to the NICE guidelines on nutritional support in adults, with particular reference to the new recommendations for best practice in refeeding syndrome.<span class="xref-bibr">3</span> These recommendations differ in parts from—and we believe improve on—previous guidelines, such as those of the Parenteral and Enteral Nutrition Group of the British Dietetic Association (box 1).<span class="xref-bibr">4</span></p><div class="style2" id="boxed-text-1"><div id="sec-1" class="subsection"><h4>Box 1 Why use the NICE guidelines on refeeding syndrome?</h4><ul class="list-unord " id="list-1"><li id="list-item-1"><p id="p-4">The guidelines are the most recent comprehensive review of the literature on refeeding syndrome</p></li><li id="list-item-2"><p id="p-5">The guideline development group was strongly multidisciplinary with wide ranging consultation with both professional and patient stakeholders </p></li><li id="list-item-3"><p id="p-6">The guidelines clearly identified points of good practice and areas for further research </p></li><li id="list-item-4"><p id="p-7">The new guidelines give explicit clinical criteria for patients “at risk” and “highly at risk” of developing refeeding syndrome, enabling better identification and prevention</p></li><li id="list-item-5"><p id="p-8">For patients with electrolyte deficits the new guidelines recommend immediate start of nutritional support at a lower rate, rather than waiting till the electrolyte imbalance has been corrected (as was recommended by previous guidelines), thus potentially avoiding further nutritional deterioration in patients</p></li></ul></div></div><div class="section" id="sec-2"><h2 class="">What is refeeding syndrome?</h2><p id="p-9">Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally<span class="xref-bibr">5</span>). 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data-delta="0"><span class="nlm-surname">Mehanna</span> <span class="nlm-given-names">H M</span></span>, <span data-delta="1"><span class="nlm-surname">Moledina</span> <span class="nlm-given-names">J</span></span>, <span data-delta="2"><span class="nlm-surname">Travis</span> <span class="nlm-given-names">J</span></span>. </body></html> </span> <span class="highwire-cite-title article-title">Refeeding syndrome: what it is, and how to prevent and treat it</span> <span class="highwire-cite-metadata" ><span class="highwire-cite-metadata-journal highwire-cite-metadata">BMJ </span><span class="highwire-cite-metadata-date highwire-cite-metadata">2008; </span><span class="highwire-cite-metadata-volume highwire-cite-metadata">336 </span><span class="highwire-cite-metadata-volume highwire-cite-metadata">:1495 </span></span> <span class="article-doi" >doi:10.1136/bmj.a301</span> </div> </div> </div> <div class="highwire-citation-formats"> <div class="highwire-citation-formats-links"> <span 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