Thiamine Before Refeeding — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

ModerateEating DisordersThiamine Before RefeedingMRCPsych Paper B

A 30-year-old woman with anorexia nervosa is admitted with a BMI of 14.5 kg/m² after negligible nutritional intake for 12 days. A supervised refeeding plan is being prepared. In addition to cautious introduction of nutrition and monitoring and replacement of electrolytes, which vitamin should be administered immediately before feeding and continued during early refeeding?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Thiamine (vitamin B1)

The correct answer is thiamine (vitamin B1). Her very low BMI and negligible intake for more than 10 days place her at high risk of refeeding problems. Carbohydrate reintroduction increases thiamine requirements; deficiency may precipitate Wernicke encephalopathy and cardiovascular or metabolic complications. NICE advises giving thiamine immediately before feeding and during the first 10 days in people at high risk, together with broader vitamin supplementation and appropriate electrolyte management. Vitamin C, folate and vitamin B12 deficiencies can occur in malnutrition but are not the specifically required pre-refeeding vitamin prophylaxis. Vitamin D is relevant principally to longer-term bone health in anorexia nervosa rather than prevention of acute refeeding complications.

Reference: NICE, Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition (CG32), recommendation 1.4.8, 2006, updated 2017. https://www.nice.org.uk/guidance/cg32/chapter/Recommendations