A 2-year-old child with severe acute malnutrition (SAM) weighing 7 kg (expected 12 kg) is admitted with bilateral pitting edema, generalized skin hyperpigmentation with 'flaky paint' desquamation, sparse, reddish, easily pluckable hair, and hepatomegaly. He is conscious but apathetic. Serum albumin is 1.4 g/dL. Which is the most dangerous complication to anticipate during refeeding?
- A Refeeding hypophosphatemia causing cardiac failure ✓
- B Hyperglycemia from carbohydrate loading
- C Hyperkalemia from muscle protein catabolism
- D Vitamin A toxicity from therapeutic supplementation
Explanation
Refeeding syndrome in SAM (kwashiorkor/marasmus) is characterized by severe hypophosphatemia occurring when carbohydrates are introduced after prolonged starvation. Insulin release drives phosphate into cells for ATP production, depleting already low serum phosphate. Severe hypophosphatemia (<0.5 mmol/L) causes cardiac arrhythmias, respiratory failure, hemolytic anemia, and death. WHO F-75 starter diet and F-100 rehabilitation diet protocols specifically address this by starting with low-energy feeds and progressing gradually. The 10 steps in SAM management include monitoring and correcting electrolyte imbalances before aggressive refeeding.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.