A 2-year-old child with severe acute malnutrition (SAM) and bilateral pitting edema is admitted. On day 2 of re-feeding, he develops rapid heart rate, respiratory distress, and altered consciousness. His serum potassium drops to 2.8 mEq/L and phosphorus to 1.1 mg/dL. What is the MOST likely complication, and what is the key pathophysiology?
- A Sepsis-induced metabolic acidosis
- B Refeeding syndrome due to intracellular shift of phosphorus and potassium during anabolism ✓
- C Hypoglycemia from inadequate caloric intake
- D Congestive heart failure from rapid fluid administration
Correct answer: B. Refeeding syndrome due to intracellular shift of phosphorus and potassium during anabolism
Explanation
Refeeding syndrome occurs when malnourished children are re-fed too rapidly, particularly with carbohydrate-rich feeds. Insulin surge during refeeding drives glucose, potassium, magnesium, and phosphorus into cells, causing severe hypophosphatemia, hypokalemia, and hypomagnesemia. The resulting cardiac arrhythmias, respiratory failure, and neurological symptoms can be fatal. WHO guidelines for SAM emphasize 'start low, go slow' with F-75 formula initially (75 kcal/100 mL) before transitioning to F-100.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.