Additionally, why are some of the symptoms fatigue and weakness if you’re getting more energy from the extra calories?
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Refeeding syndrome occurs when you feed a starved person too much food too quickly. You basically startle the body into rapid digestion of the food and it leads to a sudden increase in production of fats/glycogen/protein that depletes a whole bunch of ions and vitamins in the process. The starved person has been relying on fat and amino acids to stay alive, but when you give them food, the blood sugar spikes up and insulin is released. Insulin is an anabolic that promotes the building of fat/glycogen/protein and these processes need phosphate, magnesium, and potassium. But in this case it occurs so rapidly to such a high extent, all these ions and other minerals are rapidly used up. This all has the potential to lead to fatal arrhythmias because stable ion gradients are absolutely essential for proper heart function.
The (sudden) extra calories you gave the person is what is causing the refeeding syndrome depletion of ions. That is why the person is showing fatigue and weakness. If you slowly increase food intake over the course of many days, then each tiny bolus of calories will properly be used up to give energy without causing any other issues.
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