During rehabilitation of a severely malnourished child (Kwashiorkor), the child develops sudden profound weakness, bradycardia and cardiac arrhythmia on day 3 of feeding. The most likely metabolic cause is:

• A Hyperglycemia from excessive carbohydrate feeding
• B Hyponatremia from excessive water intake
• C Refeeding hypophosphatemia ✓
• D Iron-deficiency anemia worsening

Explanation

Refeeding syndrome is a critical complication of re-initiating feeding in severely malnourished children. Rapid carbohydrate intake stimulates insulin secretion, which drives phosphate (along with glucose, K+ and Mg2+) into cells, precipitating profound hypophosphatemia. Hypophosphatemia impairs ATP synthesis, causing cardiorespiratory failure (weak cardiac muscle, arrhythmias), hemolytic anemia, and respiratory failure. WHO management protocols use a low-carbohydrate F-75 starter formula and gradual caloric increase to prevent this. Hyperglycemia is a concern but is not the cause of cardiac collapse.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.