Dr. Abhishek Shukla explained that refeeding syndrome is a serious metabolic disturbance that occurs when nutrition is suddenly reintroduced after prolonged starvation or severe malnutrition. During starvation, the body suppresses insulin, slows metabolism, and switches to fat and protein breakdown for survival. The moment carbohydrates are given suddenly, whether orally, enterally, or intravenously, basal insulin levels rise sharply, driving glucose along with potassium, phosphate, and magnesium into the cells. This leads to rapid depletion of these electrolytes in the blood, creating a clinically dangerous situation.

He highlighted that the classical abnormalities include hypophosphatemia, hypokalemia, and hypomagnesemia each capable of causing life-threatening complications. Severe phosphate drop can result in respiratory failure, hemolysis, seizures, and cardiac dysfunction. Hypokalemia can trigger ventricular arrhythmias, muscle weakness, and paralysis, while hypomagnesemia contributes to QT prolongation and refractory hypokalemia. Fluid overload, sodium retention, and thiamine deficiency further worsen the risk. This is why even giving food can lead to death if refeeding is done rapidly in a severely malnourished patient.

Dr. Abhishek emphasized that refeeding syndrome is common in people with chronic malnutrition, anorexia nervosa, prolonged fasting, cancer cachexia, chronic alcoholism, uncontrolled diabetes, elderly individuals with negligible intake, and long ICU stays. The correct medical protocol is to start feeding slowly, usually at 10–20 kcal/kg/day, give thiamine before any nutrition, closely monitor electrolytes every 6–12 hours, and replace phosphate, potassium, and magnesium proactively. Careful fluid management and avoiding unnecessary insulin help prevent complications. With a gradual, well-supervised approach, refeeding becomes safe and life-saving.