This guidance has been endorsed by the BSG, and was published in 2025.
 

Introduction

The Royal College of Psychiatrists recently reported an 79% increase in hospital admissions in adults with eating disorders (ED) in the last five years1 . Many of these patients will be at high risk of refeeding syndrome according to the criteria in the Medical Emergencies in Eating Disorders (MEED)2 guidelines and NICE CG323 and managed on general medical wards. While serious but rare consequences of inappropriate refeeding including death are well publicised, more common problems related to fluid overload can be overlooked but lead to serious morbidity and prolonged length of stay1, 4, 5. These often relate to poor fluid and electrolyte management during refeeding and apply to all patients at high risk of refeeding syndrome, not just those with eating disorders. Metabolically stressed patients may be at highest risk of fluid and electrolyte disturbance. The importance of identifying and addressing the underlying causes of malnutrition cannot be understated and guidance on this is provided in NICE CG323 and MEED2 .