Table 3.

Patient management based on refeeding syndrome risk classification

	Low risk	High risk	Very-high risk
Nutritional support	Days 1–3: 15–25 kcal/kg/day Day 4: 30 kcal/kg/day From Day 5: full requirements	Days 1–3: 10–15 kcal/kg/day Days 4–5: 15–25 kcal/kg/day Day 6: 25–30 kcal/kg/day From Day 7: full requirements	Days 1–3: 5–10 kcal/kg/day Days 4–6: 10–20 kcal/kg/day Days 7–9: 20–30 kcal/kg/day From Day 10: full requirements
Fluid management	30–35 mg/kg/day	Days 1–3: 25–30 ml/kg/day From Day 4: 30–35 ml/kg/day	Days 1–3: 20–35 ml/kg/day Days 4–6: 25–30 ml/kg/day From Day 4: 30–35 ml/kg/day
Sodium restriction	No sodium restriction	Days 1–7: <1 mmol/kg/day	Days 1–10: <1 mmol/kg/day
Phosphate	Mild deficiency (0.6–0.8 mmol/L): <0.5 mmol/L IV replacement with 20–24 mmol of MgSO4 (4–6 g) over 4–8 h. Reassess every 8–12 h Moderate–severe deficiency (<0.6 mmol/L): IV replacement with 0.6 mmol/kg/day of ${\text{PO}}_4^{–}$ (as K3PO4 or Na3PO4) over 8–12 h. Check levels after 8–12 h and repeat infusion if necessary (maximum of 50 mmol of PO4 in 24 h)
Potassium	Mild deficiency (3.1–3.5 mmol/l): oral replacement with 20 mmol (as potassium chloride, KCL, or other salts) or IV replacement with 20 mmol of KCL over 4–8 h Moderate deficiency (2.5–3 mmol/l): IV replacement with 20–40 mmol of KCL over 4–8 h. Check levels after 8 h; if not normal, give an additional 20 mmol of KCL Severe deficiency (<2.5 mmol/L): IV replacement with 40 mmol of KCL over 4–8 h. Check levels after 8 h; if not normal, give an additional 40 mmol of KCL
Magnesium	Mild–moderate deficiency (0.5–0.7 mmol/L): oral replacement with 10–15 mmol of MgCl2, Mg-citrate, or Mg-L-aspartate. Oral Mg should be given in divided doses to minimize diarrhoea (absorption process is saturated at ∼5–10 mmol of Mg) Severe deficiency (<0.5 mmol/L): IV replacement with 20–24 mmol of MgSO4 (4–6 g) over 4–8 h. Reassess every 8–12 h
Thiamine	200 or 300 mg/day for 10 days
Multivitamins	For 10 days