A 2-year-old child with severe acute malnutrition (SAM) is admitted. On day 2, blood glucose drops to 35 mg/dL and child becomes hypothermic (temperature 35.2°C). According to WHO 10-step protocol for SAM management, which electrolyte abnormality is most dangerous during the first week (refeeding phase)?

• A Hypernatraemia
• B Hypokalaemia and hypophosphataemia (refeeding syndrome) ✓
• C Hypercalcaemia from vitamin D supplementation
• D Metabolic alkalosis from nasogastric feeds

Explanation

During refeeding of SAM children, carbohydrate intake triggers insulin release, driving potassium and phosphate into cells, precipitating potentially fatal hypokalaemia and hypophosphataemia (refeeding syndrome). The WHO 10-step protocol specifically uses F-75 formula with restricted protein and energy in the initial stabilization phase to prevent this. Hypernatraemia and hypercalcaemia are concerns in other settings. Metabolic alkalosis is not a primary concern in standard refeeding.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.