How does refeeding syndrome cause pitting edema?

Medical Sciences Asked by D.Tan on August 29, 2021

In the answer to "How do you feed a starving person in a way that won’t kill them?", it is mentioned that refeeding syndrome can cause peripheral edema. How does this occur?

One Answer

During refeeding syndrome (RFS), intake of carbohydrates causes a massive surge in insulin levels, leading to electrolyte abnormalities. Increased insulin also caused sodium and water retention independent to changes of renal GFR and RPF [1]. Water retention increases capillary hydrostatic pressure, leading to peripheral edema.

Another possible contributor to peripheral edema during RFS is hypoalbuminemia, which decreases capillary oncotic pressure [2].


  1. "The Effect of Insulin on Renal Sodium Metabolism". R.A. DeFronzo
  2. "Refeeding syndrome". J. Fuentebella, J.A. Kerner

Correct answer by D.Tan on August 29, 2021

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