How can refeeding syndrome develop in patients?

Refeeding syndrome develops predominantly in malnourished patients when feeding is restarted after a period of fasting or malnutrition. This condition arises due to the sudden influx of carbohydrates, which stimulates insulin secretion and leads to rapid shifts in electrolytes, particularly phosphate, potassium, and magnesium. When patients are malnourished, their body often adapts to low nutrient intake, which can lead to depleted stores of these electrolytes.

As feeding resumes, particularly with high-caloric or carbohydrate-rich diets, the body’s metabolic demands increase sharply. This can overwhelm the body’s ability to manage electrolytes, resulting in deficiencies and potential complications, such as cardiac issues, respiratory failure, or neurological problems. The risk of refeeding syndrome underscores the importance of carefully monitoring and gradually increasing caloric intake in patients who are malnourished or have been in a state of prolonged fasting or low intake.