Parenteral nutrition and refeeding syndrome — structured clinical encounter

Station 1 — recognition and definition

Asked for my first impression, I explain that a malnourished adolescent with anorexia nervosa, admitted for refeeding after prolonged negligible intake and significant weight loss, is at the highest risk of refeeding syndrome. I would define refeeding syndrome as the metabolic and fluid disturbance that follows the reintroduction of carbohydrate to a starved body. The phosphate fall and the oedema on day two tell me the syndrome is already declaring itself, and I would treat this as an active metabolic emergency requiring correction of the electrolytes, slowing of the calories, and management of the fluid overload. ^[5]