A 45-year-old patient with severe malnutrition (BMI 14 kg/m²) is admitted for nutritional rehabilitation. To prevent refeeding syndrome, which of the following strategies is recommended?
- A Start with 50% of caloric goal and advance to 100% in 24 hours
- B Delay feeding until serum phosphate normalizes spontaneously
- C Begin with 5-10 kcal/kg/day, provide thiamine, and monitor phosphate closely ✓
- D Initiate full caloric needs via parenteral nutrition to bypass the gut
Correct answer: C. Begin with 5-10 kcal/kg/day, provide thiamine, and monitor phosphate closely
Explanation
Refeeding syndrome is driven by a shift of phosphate, potassium, and magnesium into cells upon reintroduction of carbohydrates, causing hypophosphatemia, cardiac failure, and arrhythmias. ESPEN guidelines recommend starting nutrition at 5-10 kcal/kg/day in high-risk patients, with thiamine supplementation and aggressive electrolyte monitoring. Delaying nutrition worsens outcomes. Parenteral nutrition carries equal risk and is not a bypass for refeeding. Slow advancement is key.
Reference: ESPEN guidelines on nutritional support in the acute care setting, 2023 ed.
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Written and medically reviewed by the StethoPrep medical team.