{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T18:37:48Z","timestamp":1791484668673,"version":"4.3.4"},"reference-count":82,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T00:00:00Z","timestamp":1748476800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Refeeding syndrome (RS) is defined as the spectrum of metabolic and biochemical disorders related to rapid nutritional replenishment after a prolonged period of fasting. It is caused by an abrupt shift in electrolytes and fluid among intra- and extracellular compartments, leading to metabolic disturbances like hypophosphatemia, vitamin deficiency, and fluid overload. RS often remains underdiagnosed due to variability in definition and diagnostic criteria adopted, overlapping clinical features with other complications and low awareness among clinicians. Critically ill individuals, particularly those admitted to intensive care units (ICUs), represent a cohort with peculiar features that may heighten RS risk due to their baseline frailty, frequent undernutrition, and the metabolic stress of acute illness. However, studies specifically conducted in ICU settings have yielded conflicting results regarding incidence rates, prognostic impact, and specific risk factors. Despite these differences, all evidence consistently highlights RS as a frequent and serious complication in critically ill patients. Early detection and prevention are essential, relying on prompt nutritional assessment at ICU admission, careful monitoring of serum electrolytes before and during refeeding, and a conservative caloric approach to nutrient reintroduction, alongside supportive therapy and electrolyte supplementation if RS manifestations occur. Clinicians should be aware of the significant prevalence and potential severity of RS in critically ill patients, along with the ongoing challenges related to its early recognition, prevention, and optimal nutritional management. This review aims to provide a comprehensive overview of the current knowledge on the incidence, prognostic impact, risk factors, clinical manifestations, and nutritional management of RS in critically ill patients while highlighting existing evidence gaps and key areas requiring clinical attention.<\/jats:p>","DOI":"10.3390\/nu17111866","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T04:27:58Z","timestamp":1748579278000},"page":"1866","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Understanding Refeeding Syndrome in Critically Ill Patients: A Narrative Review"],"prefix":"10.3390","volume":"17","author":[{"given":"Raffaele","family":"Borriello","sequence":"first","affiliation":[{"name":"CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Esposto","sequence":"additional","affiliation":[{"name":"CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Elena","family":"Ainora","sequence":"additional","affiliation":[{"name":"CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Podagrosi","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuliano","family":"Ferrone","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Mignini","sequence":"additional","affiliation":[{"name":"CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Galasso","sequence":"additional","affiliation":[{"name":"CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Largo A. 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Head Neck Oncol., 1.","DOI":"10.1186\/1758-3284-1-4"},{"key":"ref_4","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":"ref_5","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/S1054-139X(97)00163-8","article-title":"Cardiac Arrest and Delirium: Presentations of the Refeeding Syndrome in Severely Malnourished Adolescents with Anorexia Nervosa","volume":"22","author":"Kohn","year":"1998","journal-title":"J. Adolesc. Health"},{"key":"ref_6","first-page":"116","article-title":"Incidence of Refeeding Syndrome in Internal Medicine Patients","volume":"74","author":"Kraaijenbrink","year":"2016","journal-title":"Neth. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Rinninella, E., D\u2019Angelo, M., Borriello, R., Galasso, T., Cintoni, M., Raoul, P., Impagnatiello, M., Annicchiarico, B.E., Gasbarrini, A., and Mele, M.C. (2022). Incidence and Impact of Refeeding Syndrome in an Internal Medicine and Gastroenterology Ward of an Italian Tertiary Referral Center: A Prospective Cohort Study. Nutrients, 14.","DOI":"10.3390\/nu14071343"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.clnesp.2021.10.006","article-title":"Refeeding Syndrome in Surgical Patients Post Initiation of Artificial Feeding, a Prospective Cohort Study in a Low-Income Country","volume":"46","author":"Buitendag","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s12603-017-0917-0","article-title":"Prevalence of Risk Factors for the Refeeding Syndrome in Older Hospitalized Patients","volume":"22","author":"Pourhassan","year":"2018","journal-title":"J. Nutr. Health Aging"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1111\/1747-0080.12872","article-title":"Risk Factors and Outcomes for Refeeding Syndrome in Acute Ischaemic Stroke Patients","volume":"81","author":"Chen","year":"2024","journal-title":"Nutr. Diet."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1002\/mus.28103","article-title":"Outcomes after Intervention for Enteral Nutrition in Patients with Amyotrophic Lateral Sclerosis in Multidisciplinary Clinics","volume":"70","author":"Fullam","year":"2024","journal-title":"Muscle Nerve"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1016\/j.braindev.2013.12.001","article-title":"Hypophosphatemia Is a Common Complication in Severely Disabled Individuals with Neurological Disorders and Is Caused by Infection, Refeeding and Fanconi Syndrome","volume":"36","author":"Saito","year":"2014","journal-title":"Brain Dev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1080\/17474086.2020.1727738","article-title":"Refeeding Syndrome in Hematological Cancer Patients\u2014Current Approach","volume":"13","author":"Szeja","year":"2020","journal-title":"Expert Rev. Hematol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e75","DOI":"10.1097\/MPG.0000000000003945","article-title":"Refeeding Syndrome in Pediatric Age, An Unknown Disease: A Narrative Review","volume":"77","author":"Corsello","year":"2023","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1002\/jpen.2474","article-title":"Recognizing Neonatal Refeeding Syndrome and Thiamin Supplementation: A Case Report","volume":"47","author":"Bradley","year":"2023","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1002\/jpen.1934","article-title":"Neonatal Refeeding Syndrome and Clinical Outcome in Extremely Low-Birth-Weight Babies: Secondary Cohort Analysis From the ProVIDe Trial","volume":"45","author":"Cormack","year":"2021","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.nut.2016.05.016","article-title":"Revisiting the Refeeding Syndrome: Results of a Systematic Review","volume":"35","author":"Friedli","year":"2017","journal-title":"Nutrition"},{"key":"ref_18","unstructured":"Netherlands, Committee on Malnutrition, Burger, G.C.E., Drummond, J.C., and Sandstead, H.R. (1948). Malnutrition and Starvation in Western Netherlands: September 1944\u2013July 1945 Pt. 1."},{"key":"ref_19","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":"ref_20","doi-asserted-by":"crossref","unstructured":"Vignaud, M., Constantin, J.-M., Ruivard, M., Villemeyre-Plane, M., Futier, E., Bazin, J.-E., Annane, D., and AZUREA Group (AnorexieRea Study Group) (2010). Refeeding Syndrome Influences Outcome of Anorexia Nervosa Patients in Intensive Care Unit: An Observational Study. Crit. Care, 14.","DOI":"10.1186\/cc9274"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.12740\/PP\/OnlineFirst\/90275","article-title":"Refeeding Syndrome as Treatment Complication of Anorexia Nervosa","volume":"53","author":"Strzelecki","year":"2019","journal-title":"Psychiatr. Pol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"324","DOI":"10.5694\/j.1326-5377.2005.tb07066.x","article-title":"Hypophosphataemia Secondary to Oral Refeeding Syndrome in a Patient with Long-term Alcohol Misuse","volume":"183","author":"Fung","year":"2005","journal-title":"Med. J. Aust."},{"key":"ref_23","first-page":"906","article-title":"Metabolic disregulation after starting feeding: \u201crefeeding\u201d syndrome: The central role of phosphate","volume":"146","author":"Baars","year":"2002","journal-title":"Ned. Tijdschr. Geneeskd."},{"key":"ref_24","first-page":"98","article-title":"The incidence of the refeeding syndrome in cancer patients who receive artificial nutritional treatment","volume":"11","year":"1996","journal-title":"Nutr. Hosp."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1111\/j.1742-1241.2007.01674.x","article-title":"Refeeding Syndrome in Cancer Patients","volume":"62","author":"Marinella","year":"2008","journal-title":"Int. J. Clin. Pract."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1111\/j.1365-2796.2005.01492.x","article-title":"The Refeeding Syndrome and Hypophosphataemia in the Elderly","volume":"257","author":"Crook","year":"2005","journal-title":"J. Intern. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/S2213-2600(15)00418-X","article-title":"Restricted versus Continued Standard Caloric Intake during the Management of Refeeding Syndrome in Critically Ill Adults: A Randomised, Parallel-Group, Multicentre, Single-Blind Controlled Trial","volume":"3","author":"Doig","year":"2015","journal-title":"Lancet Respir. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1016\/j.clnu.2017.08.001","article-title":"Impact of Caloric Intake in Critically Ill Patients with, and without, Refeeding Syndrome: A Retrospective Study","volume":"37","author":"Olthof","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1001\/archsurg.1996.01430220037007","article-title":"Refeeding Hypophosphatemia in Critically Ill Patients in an Intensive Care Unit. A Prospective Study","volume":"131","author":"Marik","year":"1996","journal-title":"Arch. Surg."},{"key":"ref_30","first-page":"358","article-title":"Refeeding Hypophosphatemia in Adolescents with Anorexia Nervosa: A Systematic Review","volume":"28","author":"Nicholls","year":"2013","journal-title":"Nutr. Clin. Pract. Off. Publ. Am. Soc. Parenter. Enter. Nutr."},{"key":"ref_31","first-page":"34","article-title":"Refeeding Syndrome or Refeeding Hypophosphatemia: A Systematic Review of Cases","volume":"27","author":"Skipper","year":"2012","journal-title":"Nutr. Clin. Pract. Off. Publ. Am. Soc. Parenter. Enter. Nutr."},{"key":"ref_32","unstructured":"National Collaborating Centre for Acute Care (UK) (2006). Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. National Institute for Health and Clinical Excellence: Guidance, National Collaborating Centre for Acute Care (UK)."},{"key":"ref_33","first-page":"3688","article-title":"The Incidence of the Refeeding Syndrome. A Systematic Review and Meta-Analyses of Literature","volume":"40","author":"Cioffi","year":"2021","journal-title":"Clin. Nutr. Edinb. Scotl."},{"key":"ref_34","first-page":"26","article-title":"Much Ado about Refeeding","volume":"28","author":"McCray","year":"2005","journal-title":"Pract. Gastroenterol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.nut.2009.11.017","article-title":"Refeeding Syndrome: Treatment Considerations Based on Collective Analysis of Literature Case Reports","volume":"26","author":"Boateng","year":"2010","journal-title":"Nutrition"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1002\/j.1875-9114.1995.tb02887.x","article-title":"The Refeeding Syndrome: An Approach to Understanding Its Complications and Preventing Its Occurrence","volume":"15","author":"Brooks","year":"1995","journal-title":"Pharmacotherapy"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Knochel, J.P. (1977). The Pathophysiology and Clinical Characteristics of Severe Hypophosphatemia. Arch. Intern. Med., 137.","DOI":"10.1001\/archinte.1977.03630140051013"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Noguchi, R., Kubota, H., Yugi, K., Toyoshima, Y., Komori, Y., Soga, T., and Kuroda, S. (2013). The Selective Control of Glycolysis, Gluconeogenesis and Glycogenesis by Temporal Insulin Patterns. Mol. Syst. Biol., 9.","DOI":"10.1038\/msb.2013.19"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1097\/MNH.0b013e3283036cbf","article-title":"Functional Roles of Na,K-ATPase Subunits","volume":"17","author":"Geering","year":"2008","journal-title":"Curr. Opin. Nephrol. Hypertens."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1021\/bi401425g","article-title":"Molecular Mechanism of Na(+),K(+)-ATPase Malfunction in Mutations Characteristic of Adrenal Hypertension","volume":"53","author":"Kopec","year":"2014","journal-title":"Biochemistry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2649","DOI":"10.1681\/ASN.2007070792","article-title":"Mechanism of Hypokalemia in Magnesium Deficiency","volume":"18","author":"Huang","year":"2007","journal-title":"J. Am. Soc. Nephrol. JASN"},{"key":"ref_42","unstructured":"Persaud-Sharma, D., Saha, S., and Trippensee, A.W. (2025). Refeeding Syndrome. StatPearls, StatPearls Publishing."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/0002-9343(86)90336-0","article-title":"Hypokalemia and Arrhythmias","volume":"80","author":"Helfant","year":"1986","journal-title":"Am. J. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"219","DOI":"10.2147\/IJNRD.S42054","article-title":"Hypomagnesemia: A Clinical Perspective","volume":"7","author":"Pham","year":"2014","journal-title":"Int. J. Nephrol. Renov. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1590\/S0066-782X2008001300013","article-title":"Thiamin Deficiency as a Cause of Reversible Cor Pulmonale","volume":"91","author":"Coelho","year":"2008","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"On behalf of the working group on nutrition and metabolism of the German Geriatric Society (DGG), Janssen, G., Pourhassan, M., Lenzen-Gro\u00dfimlinghaus, R., J\u00e4ger, M., Sch\u00e4fer, R., Spamer, C., Cuvelier, I., Volkert, D., and Wirth, R. (2019). The Refeeding Syndrome Revisited: You Can Only Diagnose What You Know. Eur. J. Clin. Nutr., 73, 1458\u20131463.","DOI":"10.1038\/s41430-019-0441-x"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/S0899-9007(01)00542-1","article-title":"The Importance of the Refeeding Syndrome","volume":"17","author":"Crook","year":"2001","journal-title":"Nutrition"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.nut.2017.09.007","article-title":"Management and Prevention of Refeeding Syndrome in Medical Inpatients: An Evidence-Based and Consensus-Supported Algorithm","volume":"47","author":"Friedli","year":"2018","journal-title":"Nutrition"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1542\/pir.2015-0152","article-title":"Refeeding Syndrome","volume":"37","author":"Pulcini","year":"2016","journal-title":"Pediatr. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Rio, A., Whelan, K., Goff, L., Reidlinger, D.P., and Smeeton, N. (2013). Occurrence of Refeeding Syndrome in Adults Started on Artificial Nutrition Support: Prospective Cohort Study. BMJ Open, 3.","DOI":"10.1136\/bmjopen-2012-002173"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1016\/S0140-6736(10)60446-1","article-title":"Critical Care and the Global Burden of Critical Illness in Adults","volume":"376","author":"Adhikari","year":"2010","journal-title":"Lancet"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1016\/S2213-8587(15)00222-3","article-title":"Nutritional Support in Critical Illness and Recovery","volume":"3","author":"Casaer","year":"2015","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1177\/0148607115625638","article-title":"Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review","volume":"41","author":"Lew","year":"2017","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1002\/jpen.2560","article-title":"Assessment of Refeeding Syndrome Definitions and 30-Day Mortality in Critically Ill Adults: A Comparison Study","volume":"47","author":"Naik","year":"2023","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1002\/ncp.11160","article-title":"Prevalence, Predictive Factors, and Outcomes of Refeeding Syndrome among Medically Critically Ill Patients: A Retrospective Cohort Study","volume":"40","author":"Tongyoo","year":"2025","journal-title":"Nutr. Clin. Pract."},{"key":"ref_56","first-page":"252","article-title":"Hypophosphatemia in Enterally Fed Patients in the Surgical Intensive Care Unit","volume":"32","author":"Fuentes","year":"2017","journal-title":"Nutr. Clin. Pract. Off. Publ. Am. Soc. Parenter. Enter. Nutr."},{"key":"ref_57","first-page":"1071","article-title":"Incidence and Outcome of Refeeding Syndrome in Neurocritically Ill Patients","volume":"40","author":"Xiong","year":"2021","journal-title":"Clin. Nutr. Edinb. Scotl."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"369","DOI":"10.3906\/sag-1211-49","article-title":"Refeeding Hypophosphatemia: A Potentially Fatal Danger in the Intensive Care Unit","volume":"44","author":"Baldane","year":"2014","journal-title":"Turk. J. Med. Sci."},{"key":"ref_59","first-page":"329","article-title":"Refeeding Hypophosphataemia after Enteral Nutrition in a Malaysian Intensive Care Unit: Risk Factors and Outcome","volume":"27","year":"2018","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Schneeweiss-Gleixner, M., Haselwanter, P., Schneeweiss, B., Zauner, C., and Riedl-Wewalka, M. (2024). Hypophosphatemia after Start of Medical Nutrition Therapy Indicates Early Refeeding Syndrome and Increased Electrolyte Requirements in Critically Ill Patients but Has No Impact on Short-Term Survival. Nutrients, 16.","DOI":"10.3390\/nu16070922"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Suzuki, S., Egi, M., Schneider, A.G., Bellomo, R., Hart, G.K., and Hegarty, C. (2013). Hypophosphatemia in Critically Ill Patients. J. Crit. Care, 28.","DOI":"10.1016\/j.jcrc.2012.10.011"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1016\/j.clnu.2020.07.034","article-title":"Mortality Associated with New Risk Classification of Developing Refeeding Syndrome in Critically Ill Patients: A Cohort Study","volume":"40","author":"Yoshida","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Bernardes, S., Stello, B.B., Milanez, D.S.J., Razzera, E.L., and Silva, F.M. (2024). Refeeding Syndrome Risk at ICU Admission Is an Independent Predictor of ICU Readmission but It Is Not Associated with Mortality or Length of Stay in Critically Ill Patients. Intensive Crit. Care Nurs., 85.","DOI":"10.1016\/j.iccn.2024.103716"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Papathanakos, G., Blot, S., and Koulenti, D. (2024). Refeeding Syndrome in the ICU: A Serious Problem Still Lacking an Evidence-Based Approach. Intensive Crit. Care Nurs., 85.","DOI":"10.1016\/j.iccn.2024.103771"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1097\/MCC.0000000000000514","article-title":"Refeeding Syndrome: Relevance for the Critically Ill Patient","volume":"24","author":"Boot","year":"2018","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Statlender, L., Raphaeli, O., Shochat, T., Robinson, E., Hellerman Itzhaki, M., Bendavid, I., Fishman, G., Singer, P., and Kagan, I. (2024). Contributing Factors to Hypophosphatemia Development in Critically Ill Ventilated Patients: A Retrospective Cohort Study. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-68688-x"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1002\/eat.22406","article-title":"Predictors of Hypophosphatemia during Refeeding of Patients with Severe Anorexia Nervosa","volume":"48","author":"Brown","year":"2015","journal-title":"Int. J. Eat. Disord."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.medin.2023.12.002","article-title":"Incidence of Hypophosphataemia after ICU Admission in Mechanically Ventilated Patients and Its Relationship with Risk Factors for Refeeding Syndrome","volume":"48","author":"Colmenero","year":"2024","journal-title":"Med. Intensiv. Engl. Ed."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1002\/ncp.11203","article-title":"Risk Factors for the Development of Refeeding Syndrome in Adults: A Systematic Review","volume":"40","author":"Zheng","year":"2025","journal-title":"Nutr. Clin. Pract."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Wang, L., Xiao, C., Chen, L., Zhang, X., and Kou, Q. (2019). Impact of Hypophosphatemia on Outcome of Patients in Intensive Care Unit: A Retrospective Cohort Study. BMC Anesthesiol., 19.","DOI":"10.1186\/s12871-019-0746-2"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Liu, N., Zhao, X.-L., Xiong, R.-Q., Chen, Q.-F., Wu, Y.-M., Lin, Z.-Z., Wang, S.-N., Wu, T., Pan, S.-Y., and Huang, K.-B. (2022). The Performances of SNAQ, GLIM, mNICE, and ASPEN for Identification of Neurocritically Ill Patients at High Risk of Developing Refeeding Syndrome. Nutrients, 14.","DOI":"10.3390\/nu14194032"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1097\/MCO.0000000000000449","article-title":"Is Refeeding Syndrome Relevant for Critically Ill Patients?","volume":"21","author":"Koekkoek","year":"2018","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"McKnight, C.L., Newberry, C., Sarav, M., Martindale, R., Hurt, R., and Daley, B. (2019). Refeeding Syndrome in the Critically Ill: A Literature Review and Clinician\u2019s Guide. Curr. Gastroenterol. Rep., 21.","DOI":"10.1007\/s11894-019-0724-3"},{"key":"ref_74","first-page":"1671","article-title":"ESPEN Practical and Partially Revised Guideline: Clinical Nutrition in the Intensive Care Unit","volume":"42","author":"Singer","year":"2023","journal-title":"Clin. Nutr. Edinb. Scotl."},{"key":"ref_75","first-page":"365","article-title":"Refeeding Hypophosphataemia Is More Common in Enteral than Parenteral Feeding in Adult in Patients","volume":"30","author":"Zeki","year":"2011","journal-title":"Clin. Nutr. Edinb. Scotl."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1002\/jpen.2267","article-title":"Guidelines for the Provision of Nutrition Support Therapy in the Adult Critically Ill Patient: The American Society for Parenteral and Enteral Nutrition","volume":"46","author":"Compher","year":"2022","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Alencar, L.d.O., Neto, J.E.F., Beserra, E.A., and Mendes, J.F.R. (2024). Nutritional Therapy in Intensive Care Unit Inpatients at Risk for Refeeding Syndrome: A Systematic Review. Nutrition, 128.","DOI":"10.1016\/j.nut.2024.112562"},{"key":"ref_78","first-page":"153","article-title":"Systematic Review of Energy Initiation Rates and Refeeding Syndrome Outcomes","volume":"36","author":"Capra","year":"2021","journal-title":"Nutr. Clin. Pract. Off. Publ. Am. Soc. Parenter. Enter. Nutr."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1002\/jpen.2605","article-title":"Association between Energy Delivery from Parenteral Nutrition and Refeeding Syndrome in Hospitalized Adults: A Retrospective Cohort Study","volume":"48","author":"Apiromruck","year":"2024","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Vahdat Shariatpanahi, Z., Vahdat Shariatpanahi, M., Shahbazi, E., and Shahbazi, S. (2022). Refeeding Syndrome and Its Related Factors in Critically Ill Coronavirus Disease 2019 Patients: A Prospective Cohort Study. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.830457"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.clnesp.2023.03.003","article-title":"Macronutrient Intake and Outcomes of ICU Patients with Refeeding Hypophosphatemia","volume":"55","author":"Rooijakkers","year":"2023","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1038\/ejcn.2017.108","article-title":"The Impact of Multidisciplinary Nutritional Team Involvement on Nutritional Care and Outcomes in a Medical Intensive Care Unit","volume":"71","author":"Jo","year":"2017","journal-title":"Eur. J. Clin. 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