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This case demonstrates the nutrition management of tube feeding in ventilated and sedated patient with the risk of refeeding syndrome. Mr S is a 60 years old Indian man admitted to Hospital Sultan Haji Ahmad Shah with an unstable angina. Previously, he was at Klinik Kesihatan, presented with left sided chest pain radiating to left arm, associated with diaphoresis, palpitation, and vomiting. He had loss of consciousness for three to five minutes. Mr S has underlying of Diabetes Mellitus Type 2, Hypertension, Ischemic Heart Disease, and history of smear positive Pulmonary Tuberculosis. The estimated height from knee height by using Suzana and Ng resulted Mr S’s height is 1.66 m and his weight is 49.7 kg by using the Ross Lab formula. He was said at the risk of refeeding syndrome as the BMI showed he is underweight (18.0 kg/m2), little nutritional intake, and unintentional weight loss. Upon meeting, he was only given 50cc of oral rehydration solution (ORS) via nasogastric feeding. Thus, current nutrition diagnosis is inadequate enteral nutrition infusion related to feeding not yet optimised as evidenced by patient only given ORS 50cc at 9am and 12pm today. The energy prescribed to Mr S was 1550 kcal/day @ 25 kcal/kg IBW and protein was 74.4g/day (1.2 g/kg IBW) in view of infection and low level of total protein. As patient is at risk of refeeding, the regime for tube feeding was step up slowly day by day. Upon two weeks of follow up, there were complications occurred to Mr S such as aspiration, bed sore Grade 1, and thrombolysis. There were improvements shown after the nutrition interventions. As a summary, there are clear guidelines of nutrition management of patient with risk of refeeding syndrome, infection, and kidney injury. Dietitian plays a crucial role in determining the nutrition implementation for the better outcome.