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Refeeding syndrome — RACP Paediatrics MCQ

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HardEmergencyRefeeding syndromeRACP Paediatrics

The same patient is medically stabilised and refeeding has commenced. On day 3 of refeeding, phosphate drops from 1.1 to 0.5 mmol/L. The patient develops confusion and tachycardia. What is the most critical immediate intervention?

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Correct answer: A — IV phosphate supplementation

Refeeding syndrome is characterised by severe hypophosphataemia (and other electrolyte shifts) during nutritional rehabilitation after starvation. Phosphate <0.5 mmol/L with symptoms (confusion, cardiac arrhythmias, respiratory failure) is a medical emergency requiring immediate IV phosphate replacement, reduced caloric intake temporarily, and continuous cardiac monitoring.

Reference: RCH Melbourne – 2023 – Eating Disorders CPG; RACP Paediatric Curriculum – Emergency