Malnutrition can be identified in many patients in both the outpatient and inpatient settings. Validated screening tools can be helpful to identify malnutrition in at-risk patients. A thorough history and physical exam is the first and most effective step in malnutrition evaluation. Management of malnutrition in patients with enterocutaneous fistula can be challenging and may require a combination of both enteral and parenteral approaches to nutritional support. Refeeding syndrome can occur with the reintroduction of caloric intake and can cause profound metabolic and electrolyte derangement.