Eating Disorders and Refeeding Syndrome

Reviewed by Kim Dennis, MD, CEDS

What is Refeeding Syndrome?

While there is no universally accepted definition of refeeding syndrome, it is generally described as the medical complications that can occur as a result of increasing caloric intake after a period of being malnourished.1 One of the populations who are at increased risk of developing refeeding syndrome are individuals with eating disorders, particularly restrictive types of eating disorders like anorexia nervosa and atypical anorexia nervosa.2

The medical complications of refeeding syndrome are usually characterized by changes in electrolyte levels and metabolic functioning and can be fatal in severe cases.1 Studies have found that compared to patients without refeeding syndrome, patients with the syndrome have an increased mortality rate and are more likely to be admitted to the intensive care unit.3 It is important, therefore, to be aware of the signs, symptoms, and risk factors of this serious condition and to seek specialized medical care as soon as possible.1 It is also important to recognize that like eating disorders, refeeding syndrome can affect people of all ages, body sizes and races.1

What are the Risk Factors for Refeeding Syndrome?

There are many factors that can increase the risk of developing refeeding syndrome. Given the serious and at times fatal health consequences of this syndrome, it is essential for those who have experienced periods of undernourishment, their loved ones, and the professionals in their lives to be aware of these risk factors so that they can receive the appropriate treatment from a qualified medical professional as early as possible. 

Risk factors for the development of refeeding syndrome can include:

  • Being undernourished or not consuming any calories for a long period of time (i.e. little or no caloric intake for more than 10 days).1
  • Having an eating disorder like anorexia nervosa, OSFED or atypical anorexia nervosa.4
  • People with very low body weight.1
  • Rapid weight loss at any weight (i.e. losing 10-15% of body mass in 3-6 months).1
  • Vomiting for a long period of time.6
  • History of diuretic or laxative misuse.1
  • Poorly managed diabetes or insulin misuse. 1,5
  • Post-bariatric surgery patients, particularly those who have experienced rapid weight loss.1,6
  • Individuals who consume large quantities of alcohol or who have a history of chronic substance use disorder(s).1,6
  • Food insecurity and homelessness.6
  • Malabsorption conditions (i.e. inflammatory bowel disease, Crohn’s disease, cystic fibrosis etc.).6,7
  • Having cancer.6
  • Experiencing physical abuse, sexual abuse and/or neglect, particularly in childhood.6
  • Having a history of refeeding syndrome.1
  • Abnormal electrolyte levels before beginning the refeeding process.1

What are the Health Consequences of Refeeding Syndrome?

The following are some of the medical complications that people with refeeding syndrome can experience:

How is Refeeding Syndrome Treated?

As stated earlier it is important to learn as much as possible about the risk factors of refeeding syndrome so it can be identified as early as possible.1 Since refeeding syndrome can lead to serious health consequences and be fatal if the condition is not carefully monitored it is strongly recommended that if someone is at risk they seek treatment from a medical professional and/or an inpatient medical facility that specializes in eating disorders and are knowledgeable about the treatment of refeeding syndrome as soon as possible.1 Since it can be difficult to find medical professionals specialized in eating disorders a first step could be seeking help from primary care physicians who can provide an initial medical evaluation and may be able to provide referrals to specialists in the area.

What to expect from your medical care team during refeeding:1

  • Your doctor might recommend taking a multivitamin prior to beginning nutritional rehabilitation.
  • Medical standards of care call for regular blood tests to monitor electrolytes during the nutritional rehabilitation process.
  • Medical personnel will also monitor your fluid intake and urine output to ensure that you are appropriately hydrated and to avoid fluid overload.
  • Your medical provider will also monitor your vital signs, liver function, cardiac health and mental health during the refeeding process.
  • Based on your blood test results, your provider might recommend supplements to correct any electrolyte deficiencies that you might have.

Learn more about eating disorder treatment here.
Learn more about finding eating disorder treatment providers in your area here.


Anemia is a condition that occurs when there are not enough healthy red blood cells in the blood to carry oxygen to the organs in the body. As a result a person can feel tired, weak, experience dizziness, shortness of breath, headaches and/or have an irregular heartbeat.8

Cardiac Arrhythmia is when a person experiences an irregular heartbeat. There are many types of arrhythmia, with two main types being: Tachycardia which is when the heath is too fast (above 100 beats per minute) and Bradycardia which is when the heart is too slow (less than 60 beats per minute).

Cardiac Failure also known as heart failure is a condition in which the heart does not pump enough blood around the body. While heart failure does not mean the heart has completely stopped, it can lead to serious health consequences that can be fatal.10

Edema is a condition where excess fluid collects in cavities or tissues in the body and causes swelling. It can lead to problems with walking, increase the risk of infection and cause other health problems like skin ulcers to develop.11

Hypoglycemia is a condition in which a person’s blood sugar (glucose) level is lower than the recommended range. Severe hypoglycemia can result in fainting, loss of consciousness and seizures.12 

Hypokalemia is a condition in which a person has low levels of potassium in their blood and in severe cases can result in heart arrhythmias and be fatal if not treated.13 

Hypomagnesemia is a condition in which a person has low levels of magnesium in their blood. In more severe instances it can result in a lack of blood flow to the heart and be fatal.14 

Hypophosphatemia is a condition in which a person has low levels of phosphate in their blood. In severe cases it can result in life-threatening health consequences like seizures and heart failure.15 

Respiratory Failure occurs when a person has difficulty breathing and their lungs cannot carry sufficient amounts of oxygen into the blood and/or remove carbon dioxide from the blood. This may lead to tiredness, irregular heartbeat, confusion or loss of consciousness.16


[1] Academy for Eating Disorders. (2021). AED Report 2021: Medical Care Standards Guide. Medical Care Standards Guide – Academy for Eating Disorders (4th ed). Available at:

[2] Jowik, K., Tyszkiewicz-Nwafor, M., & Słopień, A. (2021). Anorexia Nervosa-What Has Changed in the State of Knowledge about Nutritional Rehabilitation for Patients over the Past 10 Years? A Review of Literature. Nutrients, 13(11), 3819. 

[3]  Heuft, L., Voigt, J., Selig, L., Stumvoll, M., Schlögl, H., & Kaiser, T. (2023). Refeeding Syndrome. Deutsches Arzteblatt international, 120(7), 107–114.

[4] da Silva, J. S. V., Seres, D. S., Sabino, K., Adams, S. C., Berdahl, G. J., Citty, S. W., Cober, M. P., Evans, D. C., Greaves, J. R., Gura, K. M., Michalski, A., Plogsted, S., Sacks, G. S., Tucker, A. M., Worthington, P., Walker, R. N., Ayers, P., & Parenteral Nutrition Safety and Clinical Practice Committees, American Society for Parenteral and Enteral Nutrition (2020). ASPEN Consensus Recommendations for Refeeding Syndrome. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 35(2), 178–195.

[5] Persaud-Sharma D, Saha S, Trippensee AW. (2022). Refeeding Syndrome In: StatPearls. Treasure Island (FL): StatPearls Publishing. Available from:

[6] Crone, C., Anzia, D. J., Fochtmann, L. J., & Dahl, D. (2023). The American Psychiatric Association practice guideline for the treatment of patients with eating disorders. American Psychiatric Association. Available at:

[7] Mosuka, E. M., Murugan, A., Thakral, A., Ngomo, M. C., Budhiraja, S., & St Victor, R. (2023). Clinical Outcomes of Refeeding Syndrome: A Systematic Review of High vs. Low-Calorie Diets for the Treatment of Anorexia Nervosa and Related Eating Disorders in Children and Adolescents. Cureus, 15(5), e39313. 

[8] National Heart Lung and Blood Institute. (2022). What is anemia? U.S. Department of Health and Human Services. 

[9] National Heart Lung and Blood Institute. (2022). What is an arrhythmia?  U.S. Department of Health and Human Services. 

[10]  National Heart Lung and Blood Institute. (2022c). What is heart failure? U.S. Department of Health and Human Services.  

[11] Hoffman , M., & Baby, D. P. (2022). Edema: Types, causes, symptoms, and treatment. WebMD.

[12] DiLonardo, M. J., & Dansinger, M. (2023). Hypoglycemia (low blood sugar): Symptoms, causes, treatment, Diet. WebMD. 

[13] Castro D. & Sharma S. (2023). Hypokalemia. StatPearls Publishing. 

[14] Gragossian A., Bashir K., Bhutta B.S., et al. (2023). Hypomagnesemia. StatPearls Publishing.

[15] Sharma S., Hashmi M.F., & Castro D. (2022). Hypophosphatemia. StatPearls Publishing.

[16] National Heart Lung and Blood Institute. (2022). What is respiratory failure? U.S. Department of Health and Human Services.