Refeeding Syndrome Risk (NICE) — free guideline decision tool
This tool applies the NICE criteria to determine high or extremely-high risk of refeeding syndrome and to guide safe feeding initiation and electrolyte monitoring.
Open guideline tool →Guideline-based
Implements the decision logic from published clinical guidelines.
Runs in your browser
No installation. Enter the patient's values and get a guideline recommendation instantly.
Data stays local
Nothing is uploaded. Results are for licensed clinicians only.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| BMI | ≥ 18.5 (0) |
|---|---|
| Unintentional weight loss (3–6 months) | < 10% (0) |
| Intake/feeding status | Largely normal (0) |
| Pre-feeding K/phosphate/magnesium | Normal (0) |
| Alcohol use history or relevant drugs (insulin/chemotherapy/antacids/diuretics) | None (0) |
→Refeeding riskDoes not meet high-risk criteria (still assess individually)
- Determination：0 major criteria, 0 minor criteria → Does not meet high-risk criteria (still assess individually) (≥ 1 major or ≥ 2 minor = high risk)
- Feeding initiation：Advance per routine nutrition support, with attention to monitoring
- Vitamins：Supplement thiamine (vitamin B1) and a B-complex/multivitamin before feeding and for the first 10 days
| BMI | < 14 (extremely high risk) |
|---|---|
| Unintentional weight loss (3–6 months) | > 15% (major) |
| Intake/feeding status | Almost none > 15 days (extremely high risk) |
| Pre-feeding K/phosphate/magnesium | Low (major) |
| Alcohol use history or relevant drugs (insulin/chemotherapy/antacids/diuretics) | Present (minor) |
→Refeeding riskExtremely high risk
- Determination：2 major criteria, 1 minor criteria, including an extremely-high-risk criterion → Extremely high risk (≥ 1 major or ≥ 2 minor = high risk)
- Feeding initiation：Extremely high risk: start at 5 kcal/kg/d, increase gradually, close monitoring (cardiac monitoring)
- Vitamins：Supplement thiamine (vitamin B1) and a B-complex/multivitamin before feeding and for the first 10 days
Common questions
What is Refeeding Syndrome Risk (NICE)?
This tool applies the NICE criteria to determine high or extremely-high risk of refeeding syndrome and to guide safe feeding initiation and electrolyte monitoring.
How is Refeeding Syndrome Risk (NICE) calculated? What is the core formula?
High risk = ≥ 1 major (BMI < 16, loss > 15%, minimal intake > 10 days, low pre-feeding K/PO4/Mg) or ≥ 2 minor criteria. Extremely high = BMI < 14 or near-no intake > 15 days. Start 10 kcal/kg/d (extreme 5), thiamine first.
When is Refeeding Syndrome Risk (NICE) used?
Use to classify risk and set the starting calorie rate, thiamine supplementation, and electrolyte monitoring before and during refeeding.
What are the key clinical points for Refeeding Syndrome Risk (NICE)?
Feeding is never delayed to correct electrolytes — potassium, phosphate, and magnesium are replaced concurrently. (original synthesis · not guideline verbatim) Thiamine is given before feeding and through the first 10 days to prevent Wernicke encephalopathy. Extremely high risk starts at just 5 kcal/kg/d with cardiac monitoring.
What are the limits and cautions when using Refeeding Syndrome Risk (NICE)?
For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
How is Refeeding Syndrome Risk (NICE) calculated in practice? Can you show a worked example?
Inputs: BMI ≥ 18.5 (0), Unintentional weight loss (3–6 months) < 10% (0), Intake/feeding status Largely normal (0), Pre-feeding K/phosphate/magnesium Normal (0), Alcohol use history or relevant drugs (insulin/chemotherapy/antacids/diuretics) None (0) → Result: Refeeding risk Does not meet high-risk criteria (still assess individually)（Determination: 0 major criteria, 0 minor criteria → Does not meet high-risk criteria (still assess individually) (≥ 1 major or ≥ 2 minor = high risk), Feeding initiation: Advance per routine nutrition support, with attention to monitoring, Vitamins: Supplement thiamine (vitamin B1) and a B-complex/multivitamin before feeding and for the first 10 days） Inputs: BMI < 14 (extremely high risk), Unintentional weight loss (3–6 months) > 15% (major), Intake/feeding status Almost none > 15 days (extremely high risk), Pre-feeding K/phosphate/magnesium Low (major), Alcohol use history or relevant drugs (insulin/chemotherapy/antacids/diuretics) Present (minor) → Result: Refeeding risk Extremely high risk（Determination: 2 major criteria, 1 minor criteria, including an extremely-high-risk criterion → Extremely high risk (≥ 1 major or ≥ 2 minor = high risk), Feeding initiation: Extremely high risk: start at 5 kcal/kg/d, increase gradually, close monitoring (cardiac monitoring), Vitamins: Supplement thiamine (vitamin B1) and a B-complex/multivitamin before feeding and for the first 10 days）
Run Refeeding Syndrome Risk (NICE) now
This tool applies the NICE criteria to determine high or extremely-high risk of refeeding syndrome and to guide safe feeding initiation and electrolyte monitoring.
Open guideline tool →For licensed clinicians. Not a substitute for clinical judgement.
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