ASPEN Consensus Recommendations for Refeeding Syndrome

Nutr Clin Pract. 2020 Apr;35(2):178-195. doi: 10.1002/ncp.10474. Epub 2020 Mar 2.


Introduction: In the spring of 2017, the American Society for Parenteral and Enteral Nutrition (ASPEN) Parenteral Nutrition Safety Committee and the Clinical Practice Committee convened an interprofessional task force to develop consensus recommendations for identifying patients with or at risk for refeeding syndrome (RS) and for avoiding and managing the condition. This report provides narrative review and consensus recommendations in hospitalized adult and pediatric populations.

Methods: Because of the variation in definitions and methods reported in the literature, a consensus process was developed. Subgroups of authors investigated specific issues through literature review. Summaries were presented to the entire group for discussion via email and teleconferences. Each section was then compiled into a master document, several revisions of which were reviewed by the committee.

Findings/recommendations: This group proposes a new clinical definition, and criteria for stratifying risk with treatment and screening strategies. The authors propose that RS diagnostic criteria be stratified as follows: a decrease in any 1, 2, or 3 of serum phosphorus, potassium, and/or magnesium levels by 10%-20% (mild), 20%-30% (moderate), or >30% and/or organ dysfunction resulting from a decrease in any of these and/or due to thiamin deficiency (severe), occurring within 5 days of reintroduction of calories.

Conclusions: These consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidance, and treatment of RS.

Keywords: consensus; magnesium; nutrition assessment; nutrition support; phosphorus; potassium; refeeding syndrome.

Publication types

  • Practice Guideline
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Consensus
  • Energy Intake
  • Enteral Nutrition / methods
  • Female
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Magnesium / blood
  • Male
  • Middle Aged
  • Nutrition Assessment
  • Parenteral Nutrition / methods
  • Phosphorus / blood
  • Potassium / blood
  • Refeeding Syndrome / diagnosis*
  • Refeeding Syndrome / epidemiology
  • Refeeding Syndrome / prevention & control
  • Refeeding Syndrome / therapy*
  • Risk Factors
  • Societies, Medical
  • Young Adult


  • Phosphorus
  • Magnesium
  • Potassium