Guidelines for refeeding the marasmic patient.

Nutritional support of the malnourished patient can be lifesaving. However, the efficacy of total parenteral nutrition in this setting depends on: a) careful estimation of energy requirements, using the Harris-Benedict equation or indirect calorimetry; b) minimizing the fluid retention which invariably complicates refeeding in marasmus; c) adequate repletion of P, K, and Mg on a daily basis; and d) accurate assessment of the rate of weight regain.