A health condition that may occur in a person who is malnourished when beginning to feed again is called refeeding syndrome. Moreover, if the food is introduced too fast, it may lead to serious and even life-threatening complications. It happens because the way our bodies change when they are deprived of nutrients. For instance, when a person begins feeding again too fast, the body may not have enough resources to make these changes.
In other words, when the feeding begins again, electrolyte deficiencies may occur in the body’s chemistry. As a result, you may experience life-threatening complications that negatively affect the muscles, lungs, heart, and brain.
How Does Refeeding Syndrome Happen?
There are some changes that occur in the body when it is starved for nutrients. These changes occur in the metabolism that converts food into energy. Therefore, the metabolism begins to metabolize its own fat and muscle instead of carbohydrates from food. As a result, the resting metabolic rate (the amount of energy you spend while resting) decreases by as much as 20%.
In addition, this type of metabolism requires fewer resources because it does not use micronutrients, vitamins, minerals, and electrolytes as the normal metabolism does. However, when the feeding begins again, the body uses micronutrients to get the job done. If the stores of these nutrients are too low, you will begin to experience symptoms and complications.
Symptoms
The symptoms of refeeding syndrome often occur differently among individuals because they depend on several factors. For example, the severity of the condition, mineral type deficiency, age, overall health, and others. Check below some symptoms:
Phosphate Deficiency
Hypophosphatemia is one of the most common features of refeeding syndrome. It negatively affects cellular processes throughout the body, which often causes symptoms. Examples include:
- Double vision
- Breathing problems
- Muscle weakness
- Difficulty swallowing (dysphagia)
- Seizures
- Cardiomyopathy (also known as heart weakness)
- Coma
Some people may have symptoms severe enough to experience organ failure, which may lead to death.
Magnesium Deficiency
This is another essential mineral in metabolism. Reduced levels of Magnesium may cause damage to all organs in the body. Therefore, you may experience the following symptoms. For example:
- Nausea
- Vomiting
- Tremors
- Seizures
- Muscle spasms
- Cardiac ischemia
- Arrhythmia (irregular heart rhythm)
- Anorexia
Potassium Deficiency
While slightly reduced Potassium levels may not cause any problems, severe deficiency may lead to the following symptoms. These include:
- Muscle cramps or weakness
- Extreme tiredness (fatigue)
- Severe constipation (often caused by paralyzed bowel movements)
- Arrhythmia
- Respiratory failure
Thiamine (Vitamin B1) Deficiency
In such cases, vitamin B1 deficiency is caused by refeeding with carbohydrates. Those who develop this type of refeeding syndrome may experience severe neurological symptoms. For example:
- Amnesia (memory loss)
- Ataxia (problems with coordination and balance)
- Vision disorders
- Hypothermia
- Delirium
- Confabulation (making false memories)
Body-Fluid Disturbances
Changes in the metabolism may also cause an unbalance of Sodium and water in the body. Hence, it may lead to fluid overload or dehydration and cause the following symptoms. Check below some examples:
- Muscle spasms
- Low blood pressure (hypotension)
- Kidney dysfunction
- Fluid in the lungs (pulmonary edema)
- Seizures
- Congestive heart (cardiac) failure
Blood Sugar Problems
Some people with refeeding syndrome may experience hyperglycemia (high blood sugar). Check below some symptoms:
- Fatigue
- Frequent urination
- Blurred vision
- Headaches
If you experience any of the symptoms listed above, immediately contact your healthcare professional.
Causes
This syndrome often occurs due to reduced stores of some micronutrients in the body. These stores are low because you are malnourished. Usually, refeeding syndrome occurs due to reduced levels of the following nutrients, including Phosphorus, Potassium, and Magnesium. A severe shift in the body’s chemistry occurs when you begin feeding again, and the body uses these electrolytes to metabolize food.
Normally, the electrolytes move fast from the blood into the cells, and if the levels of these electrolytes are low, it may lead to “deficiencies”. As a result, it causes multiple complications that are often noticed in people with refeeding syndrome.
Risk Factors
While anyone who begins refeeding after being malnourished may develop this condition, some factors could increase your risk of developing it. Check below some examples:
- Malabsorption disorders – These include inflammatory bowel disease (IBD), chronic pancreatitis, and others.
- Long-term parental nutrition (feeding through IV)
- Cancer and chemotherapy
- Unmanaged diabetes
- Alcohol use disorder
- Misuse of Antacids or Diuretics
- Eating disorders (such as anorexia nervosa, bulimia nervosa, and others)
- Food deprivation for more than 1 week
- Recent loss of more than 10% of body weight
What Happens if Refeeding Syndrome is Left Untreated?
People who develop this disorder may also experience some serious complications, especially if they do not get medical care as soon as possible. Check below some examples:
- Cardiovascular problems
- Electrolyte imbalances
- Respiratory issues
- Neurological disturbances
- Wernicke’s encephalopathy
- Korsakoff’s syndrome
- Anemia
- Edema
- Coma
- Death
This article does not contain a complete list of refeeding syndrome complications. Furthermore, you can consult with your doctor about ways to reduce the risk or prevent previous complications.
How to Prevent Refeeding Syndrome?
While it is not always possible to prevent this condition, the following tips may help reduce the risk. For example:
- Manage chronic health conditions that may cause malnutrition. Usually, doctors recommend supplements (including minerals and vitamins) to replace missing nutrients.
- If you plan to engage in prolonged fasting, it is advised to do so under medical supervision.
- Avoid alcoholic beverages, drugs, and prescription medicines in large amounts.
Diagnosis
First, doctors will perform a physical examination to check for abnormalities linked to the disease. If you have symptoms that indicate refeeding syndrome, doctors may perform blood tests to determine the specific imbalances you have.
Treatment
Once you are diagnosed with this condition, doctors often recommend micronutrients to replace the missing ones. It helps the body to be prepared to metabolize carbohydrates. However, if you do not start refeeding, the blood tests may not show electrolyte deficiencies. That’s why an electrolyte imbalance occurs after you start feeding again.
After you begin the treatment, physicians will monitor electrolyte levels regularly to make sure they do not drop to dangerous levels.
Usually, people begin to feel better shortly after doctors diagnose the condition. However, the refeeding process often takes several weeks.
Frequently Asked Questions
Can you survive refeeding syndrome?
While most complications of refeeding syndrome are mild, sometimes people may develop a life-threatening complication that may lead to death. If the imbalances are treated, almost all symptoms are reversible.
What are the symptoms of refeeding syndrome?
Those who develop this syndrome often experience the following symptoms. For example, pulmonary edema, seizures, heart failure, organ dysfunction, and hypotension (low blood pressure). Go to the nearest emergency room (ER) or call 911 if any of the previous symptoms occur.
How long does it take to become malnourished?
While some people may develop malnutrition within a day or two if not consuming enough nutrients, others may develop it after several weeks of inadequate intake. However, there are some factors that affect the time it takes to become malnourished. For example, the severity of nutrient deficiency, age, sex, activity level, existing health conditions, and others. If you have any other questions, ask your healthcare provider.
