⚠️ 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.
Refeeding Syndrome Risk (NICE)
BMI
Unintentional weight loss (3–6 months)
Intake/feeding status
Pre-feeding K/phosphate/magnesium
Alcohol use history or relevant drugs (insulin/chemotherapy/antacids/diuretics)
When to use
Use to classify risk and set the starting calorie rate, thiamine supplementation, and electrolyte monitoring before and during refeeding.
How it works
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.
Key points
- 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.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.