INS and nutritional deficiency disease: Risk factors for refeeding syndrome include severe malnutrition with a BMI < 18.5 kg/m2, unintentional weight loss > 10% within 3–6 months, very little or no food intake for >5 days, and a history of alcohol misuse or drugs, including insulin, chemotherapy, antacids, or diuretics, and should be considered relative contraindications to starting TPN at home [22,23].