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Refeeding syndrome — DTM&H MCQ

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HardNutrition and micronutrient deficienciesRefeeding syndromeDTM&H

A severely malnourished adolescent starts nutritional rehabilitation and develops weakness, arrhythmia and low phosphate after rapid high-calorie feeding. What is the most appropriate treatment?

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Correct answer: B — Slow feeding with electrolyte replacement

Slow feeding with electrolyte replacement is the single best answer because refeeding syndrome results from insulin-driven intracellular electrolyte shifts, especially hypophosphataemia. High-protein loading without monitoring is plausible in a related presentation, but it is less appropriate because it does not fit the key discriminator in this vignette. The teaching point is that careful staged feeding with phosphate, potassium, magnesium and thiamine support is needed.

Reference: WHO guideline updates on malnutrition and micronutrients; Manson's Tropical Diseases