⚠️ 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.
Clinical takeaway
Feeding is never delayed to correct electrolytes — potassium, phosphate, and magnesium are replaced concurrently. (original synthesis · not guideline verbatim)
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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.
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
Frequently asked 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）