A 14-month-old child with severe acute malnutrition (SAM) is admitted with edema, miserable facies, skin changes, and weight-for-height Z-score < -3. On day 2 of therapeutic feeding with F-75 formula, the child develops worsening lethargy, bradycardia, and hypotension. Which electrolyte disturbance is MOST responsible?

• A Hypernatremia from high-protein feeds
• B Refeeding hypophosphatemia ✓
• C Hyperkalemia from cellular lysis
• D Hypercalcemia from vitamin D supplementation

Explanation

Refeeding syndrome in SAM occurs when carbohydrate reintroduction stimulates insulin release, driving phosphate, potassium, and magnesium into cells along with glucose. Children with SAM already have depleted intracellular phosphate stores; rapid anabolism causes severe hypophosphatemia, leading to cardiac dysfunction, respiratory failure, and neurological deterioration. F-75 formula is designed to be low-energy to minimize this risk during the stabilization phase; F-100 replaces it only after edema resolves and appetite returns.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.