Refeeding syndrome occurs after reintroducing nutrition in a severely malnourished person. It predominantly involves disturbances in which electrolytes?

• A. Phosphorus, potassium, and magnesium
• B. Sodium and chloride
• C. Calcium and bicarbonate
• D. Iron and zinc

Answer: (A)

Refeeding syndrome happens when nutrition is restarted after severe malnutrition and the body suddenly shifts nutrients and electrolytes into cells. The most characteristic disturbances are low phosphate, potassium, and magnesium in the blood. When feeding resumes, insulin drives glucose into cells, and phosphate is needed to make ATP and other cellular compounds, so serum phosphate drops as it moves into cells and is used up. Potassium and magnesium also shift into cells with the insulin surge, leading to low serum levels. These changes can cause serious issues like muscle weakness, heart rhythm problems, and respiratory failure if not anticipated and corrected. Sodium and chloride disturbances can occur with fluid shifts, but they aren’t the defining pattern of refeeding syndrome. Calcium and bicarbonate aren’t the primary electrolytic problems in this situation, and iron and zinc are minerals but not the electrolytes chiefly affected during early refeeding.