A 2-year-old child with severe acute malnutrition (SAM) is admitted with bilateral pitting oedema to the knees, sparse reddish-brown hair, and hepatomegaly. Blood glucose is 2.1 mmol/L. On day 2, the child develops diarrhoea, and the team decides to give ready-to-use therapeutic food (RUTF). Which electrolyte is SPECIFICALLY low in kwashiorkor and predisposes to potentially fatal arrhythmias during refeeding?
- A Sodium
- B Potassium
- C Calcium
- D Phosphate ✓
Explanation
In SAM/kwashiorkor, total body phosphate is depleted despite often-normal serum levels. On refeeding with carbohydrate-rich RUTF, insulin surges drive phosphate, potassium, and magnesium into cells, precipitating refeeding syndrome. Severe hypophosphataemia causes ATP depletion, haemolysis, myocardial dysfunction, and life-threatening arrhythmias. WHO protocols for SAM management specifically restrict carbohydrate load in the initial stabilisation phase (F-75 formula) precisely to avoid precipitating refeeding syndrome. Potassium and magnesium are also low but phosphate-driven cardiac effects are the primary concern.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.