A severely malnourished child admitted for therapeutic feeding develops sudden clinical deterioration with abdominal distension, hypothermia, bradycardia, and hypoglycaemia during the first 48 hours of management. What is the most likely cause?
- A Refeeding syndrome due to rapid introduction of high-calorie diet ✓
- B Septicaemia with gram-negative bacteraemia
- C Acute heart failure from rapid fluid administration
- D Hypocalcaemia causing cardiac arrhythmia
Explanation
Refeeding syndrome is a life-threatening metabolic complication of too-rapid nutritional rehabilitation in severely malnourished children. When carbohydrate and calories are introduced rapidly, there is a sudden shift of phosphate, potassium, and magnesium from extracellular to intracellular space (driven by insulin surge), causing severe hypophosphataemia, hypokalaemia, and hypomagnesaemia. This produces cardiac arrhythmias, acute heart failure, respiratory failure, and neurological complications. The WHO-SAM management protocol starts with F-75 formula (low calorie, low protein, low sodium) for the first 1–2 weeks to avoid this complication, then transitions to F-100. Rapid fluid administration causes heart failure, but the scenario best fits refeeding syndrome given the timing and metabolic context.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.