Low serum phosphate is not diagnostic for refeeding syndrome in critical care

Introduction Refeeding syndrome (RFS) is a complication of malnutrition. It consists of electrolyte derangements and organ failure. National Institute of Clinical Excellence (NICE) have outlined specific risk factors for identifying patients at risk of RFS, including low levels of phosphate, potassium and magnesium before feed, low body mass index, starving for >5 days, weight loss, history of alcohol abuse and drugs including insulin, diuretics, chemotherapy and antacids. Hypophosphataemia is a common phenomenon in critically ill patients, but may also indicate RFS. As there are no specific criteria for diagnosing RFS in critical illness, hypophosphataemic patients are often nutritionally restricted to prevent development of RFS.