Understanding Refeeding Syndrome: The Impact of Prolonged Fasting That Flood Victims May Face

Besides the loss of property and close relatives, some flood victims in southern Thailand may develop "Refeeding syndrome," a bodily reaction following several days of fasting.

What is Refeeding syndrome?

Information fromCleveland Clinicstates that Refeeding syndrome occurs when someone who has been malnourished for a long time starts eating again. If feeding begins too quickly, the body cannot adjust, causing drastic shifts in electrolyte and chemical balances. This affects muscles, lungs, heart, and brain, potentially leading to life-threatening conditions.

The causes of Refeeding syndrome come from two main factors.

• When the body lacks food, it changes its metabolism by breaking down fat and muscle for energy and slows metabolism to conserve energy.
• When feeding restarts, the body resumes normal carbohydrate metabolism, which requires large amounts of electrolytes. If electrolyte stores are low, the rapid shift of electrolytes from blood into cells causes a sharp drop in blood electrolyte levels, leading to severe deficiencies.

Who is at risk for Refeeding syndrome?

• Those who have lost more than 10% of their body weight recently.
• Individuals who have fasted for more than seven days under high physical stress.
• Patients with eating disorders such as anorexia or bulimia.
• Those with malabsorption issues, like chronic intestinal inflammation.
• Cancer patients undergoing chemotherapy.
• Diabetics with uncontrolled blood sugar levels.
• Chronic alcohol users.
• People using antacids or diuretics for prolonged periods.

Symptoms of Refeeding syndrome.

Most symptoms result from deficiencies in three key electrolytes—phosphorus, potassium, and magnesium—as well as vitamin B1 deficiency and abnormal water balance. These nutrient shortages cause various clinical signs.

• Phosphorus deficiency, the most common, leads to muscle weakness, breathing difficulties, double vision, swallowing problems, seizures, coma, or heart failure.
• Magnesium deficiency causes nausea, vomiting, tremors, muscle spasms, and irregular heartbeat.
• Potassium deficiency results in cramps, severe constipation, respiratory failure, and irregular heartbeat.
• Vitamin B1 deficiency manifests as confusion, balance problems, memory loss, and hallucinations.
• Water imbalance may cause dehydration or fluid overload, such as pulmonary edema or heart failure.
• High blood sugar causes headaches, blurred vision, frequent urination, and fatigue.

Diagnosis and treatment of Refeeding syndrome.

Diagnosis involves checking vital signs and blood electrolyte levels. Treatment includes the following methods.

1. Before starting feeding,

doctors test blood electrolyte levels and supplement any deficiencies before or along with feeding.

2. During feeding,

food is introduced gradually with daily blood monitoring (symptoms usually appear within the first five days). If symptoms arise, feeding is slowed, carbohydrate intake is reduced, and intravenous electrolyte supplements are given.

3. Recovery period,  

if detected early, symptoms improve quickly after electrolyte correction, but restoring the original nutritional status may take several weeks.

Although this condition can be fatal, most cases fully recover if doctors promptly detect and correct electrolyte imbalances.

Prevention of Refeeding syndrome.

• People with chronic illnesses at risk of malnutrition should manage their conditions and take vitamins as prescribed.
• Prolonged fasting should be done under medical supervision.
• Avoid excessive alcohol consumption or overuse of certain medications.

Refeeding syndrome is a complex and delicate complication. Nutritional rehabilitation should not be rushed and must be closely supervised by medical professionals to ensure safety.