{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T12:47:29Z","timestamp":1791377249059,"version":"4.3.2"},"reference-count":31,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Frontline Gastroenterol"],"accepted":{"date-parts":[[2019,12,15]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:p>Refeeding problems have been recognised since the the liberation of starved communities under siege. The main clinical problems may relate to hypophosphataemia, hypomagnesaemia and hypokalaemia with a risk of sudden death; thiamine deficiency with the risk of Wernike\u2019s encephalopathy\/Korsakoff psychosis and sodium\/water retention. The problems are greatest with oral\/enteral feeding and especially with carbohydrate due to it increasing plasma insulin and thus glucose entry into cells. It is difficult to predict patients at risk of refeeding problems so there must be a high clinical suspicion on refeeding any malnourished patient (including any who have had no or very little nutrition for over <jats:underline>\n                     <jats:italic>5<\/jats:italic>\n                  <\/jats:underline> \n                  <jats:italic>days<\/jats:italic>). Generous vitamin and electrolyte supplementation may be given while monitoring closely and increasing the calorie intake reasonably rapidly from 10 to 20 kcal\/kg\/24\u2009hours. Often patients in this category are not hungry, but over the course of a few days, the restoration of their appetite is an indication that the risks of refeeding have been managed and it is now safe to increase the feed aiming for repletion. If problems do occur, the feed should be slowed to the previous day\u2019s amount<jats:underline>,<\/jats:underline> reduced further or rarely stopped while fluid and electrolyte issues are corrected.<\/jats:p>","DOI":"10.1136\/flgastro-2018-101065","type":"journal-article","created":{"date-parts":[[2019,12,30]],"date-time":"2019-12-30T17:15:33Z","timestamp":1577726133000},"page":"404-409","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":44,"title":["Refeeding syndrome : physiological background and practical management"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0745-5564","authenticated-orcid":false,"given":"Aminda","family":"De Silva","sequence":"first","affiliation":[{"name":"Gastroenterology, Royal Berkshire NHS Foundation Trust, Reading, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy M D","family":"Nightingale","sequence":"additional","affiliation":[{"name":"Gastroenterology, St Marks Hospital, Harrow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,12,30]]},"reference":[{"key":"2025090708072785000_11.5.404.1","unstructured":"Josephus F . Chapter XIII, paragraph 4. In: Whiston W , ed. The wars of the Jews or history of the destruction of Jerusalem, 2009."},{"key":"2025090708072785000_11.5.404.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1948.02890520001001"},{"key":"2025090708072785000_11.5.404.3","doi-asserted-by":"crossref","first-page":"69","DOI":"10.7326\/0003-4819-35-1-69","article-title":"A clinical study of malnutrition in Japanese prisoners of war","volume":"35","author":"Schnitker","year":"1951","journal-title":"Ann Intern Med"},{"key":"2025090708072785000_11.5.404.4","unstructured":"Burger GCE , Drummond JC , Sanstread HR . Part I and II. In: Malnutrition and starvation in Estern Netherlands. The Hague General State Printing Office, 1948."},{"key":"2025090708072785000_11.5.404.5","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1093\/ajcn\/34.3.393","article-title":"Death resulting from overzealous total parenteral nutrition: the refeeding syndrome revisited","volume":"34","author":"Weinsier","year":"1981","journal-title":"Am J Clin Nutr"},{"key":"2025090708072785000_11.5.404.6","unstructured":"Stewart JAD , Mason DG , Smith N , et al . A mixed bag. An enquiry into the care of hospital patients receiving parenteral nutrition. A report by the National confidential enquiry into patient outcome and death 2010."},{"key":"2025090708072785000_11.5.404.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0899-9007(01)00542-1"},{"key":"2025090708072785000_11.5.404.8","doi-asserted-by":"publisher","DOI":"10.1177\/1756283X11430859"},{"key":"2025090708072785000_11.5.404.9","unstructured":"Victor M , Adams RD , Collins GH . The Wernicke Korsakoff Syndrome, F.A. Philadelphia: Davis, 1989."},{"key":"2025090708072785000_11.5.404.10","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1093\/ajcn\/24.7.869","article-title":"Water and sodium retention in the fasted and refed human","volume":"24","author":"Gozansky","year":"1971","journal-title":"Am J Clin Nutr"},{"key":"2025090708072785000_11.5.404.11","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/BF00252649","article-title":"The effect of insulin on renal sodium metabolism. A review with clinical implications","volume":"21","author":"DeFronzo","year":"1981","journal-title":"Diabetologia"},{"key":"2025090708072785000_11.5.404.12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a301"},{"key":"2025090708072785000_11.5.404.13","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1988.00380010155016"},{"key":"2025090708072785000_11.5.404.14","first-page":"365","article-title":"Severe hypophosphatemia in hospitalized patients","volume":"16","author":"Camp","year":"1990","journal-title":"Miner Electrolyte Metab"},{"key":"2025090708072785000_11.5.404.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.nut.2014.02.019"},{"key":"2025090708072785000_11.5.404.16","unstructured":"Robinson DP . MARSIPAN: management of really sick patients with anorexia nervosa. 2nd edn, 2014."},{"key":"2025090708072785000_11.5.404.17","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(80)90250-8"},{"key":"2025090708072785000_11.5.404.18","doi-asserted-by":"crossref","first-page":"69","DOI":"10.52964\/AMJA.0470","article-title":"Complications of emergency refeeding in anorexia nervosa: case series and review","volume":"10","author":"Webb","year":"2011","journal-title":"Acute Med"},{"key":"2025090708072785000_11.5.404.19","unstructured":"Jackson AA . Severe malnutrition chapter 10.4 1054, Oxford textbook of medicine. 4th ed. Warrell, Cox & Firth, 2005."},{"key":"2025090708072785000_11.5.404.20","unstructured":"National Institute for Health en Clinical Excellence . Nutrition support in adults. Clinical guidelines, 2006."},{"key":"2025090708072785000_11.5.404.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2010.12.001"},{"key":"2025090708072785000_11.5.404.22","doi-asserted-by":"publisher","DOI":"10.1017\/S0007114511001097"},{"key":"2025090708072785000_11.5.404.23","doi-asserted-by":"publisher","DOI":"10.1177\/0004563214523739"},{"key":"2025090708072785000_11.5.404.24","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(64)90011-X"},{"key":"2025090708072785000_11.5.404.25","unstructured":"Ashworth A , Khanum S , Jackson A , et al . Guidelines for the inpatient treatment of severely malnourished children. World Health Organization, 2003."},{"key":"2025090708072785000_11.5.404.26","unstructured":"Jackson AA . Severe Malnutrition Chapter 10.4 1054. In: Oxford textbook of medicine. 4th edn. Warrell, Cox & Firth, 2005."},{"key":"2025090708072785000_11.5.404.27","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.a680","article-title":"Attitudes to NICE guidance on refeeding syndrome","volume":"337","author":"De Silva","year":"2008","journal-title":"BMJ"},{"key":"2025090708072785000_11.5.404.28","unstructured":"Culkin A , White R . Refeeding syndrome. In: A pocket guide to clinical nutrition. 5th edn. British Dietetic Association, 2018."},{"key":"2025090708072785000_11.5.404.29","unstructured":"British National formulary (BNF). Available: bnf.nice.org.uk"},{"key":"2025090708072785000_11.5.404.30","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(12)80667-6"},{"key":"2025090708072785000_11.5.404.31","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1002\/eat.22482","article-title":"A systematic review of approaches to refeeding in patients with anorexia nervosa","volume":"49","author":"Garber","year":"2016","journal-title":"Int J Eat Disord"}],"container-title":["Frontline Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/flgastro-2018-101065","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T15:07:35Z","timestamp":1757257655000},"score":1,"resource":{"primary":{"URL":"https:\/\/fg.bmj.com\/lookup\/doi\/10.1136\/flgastro-2018-101065"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,30]]},"references-count":31,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,8,7]]},"published-print":{"date-parts":[[2020,9]]}},"alternative-id":["10.1136\/flgastro-2018-101065"],"URL":"https:\/\/doi.org\/10.1136\/flgastro-2018-101065","relation":{},"ISSN":["2041-4137","2041-4145"],"issn-type":[{"value":"2041-4137","type":"print"},{"value":"2041-4145","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12,30]]}}}