Parenteral nutrition and refeeding syndrome — formative SAQs

SAQ 1 — The malnourished adolescent restarted on feeding (10 marks, 15 minutes)

A 15-year-old girl with anorexia nervosa is admitted for refeeding after six weeks of negligible intake and a 15 per cent weight loss. Her body mass index is 15. On day two of a refeeding regimen the phosphate has fallen, she is oedematous, and her heart rate is rising. ^[5]

a) Define refeeding syndrome and explain the biochemical mechanism by which restarting carbohydrate drives phosphate, potassium and magnesium into the cell and depletes thiamine. (3 marks) ^{[5] [6]}

b) Identify the features in this history that place her at high risk of refeeding syndrome, using the ASPEN consensus risk stratification. (2 marks) ^[5]

c) Outline the prevention and management you should have instituted before and during refeeding, naming thiamine, conservative starting calories, and the correction and monitoring of phosphate, potassium and magnesium. (3 marks) ^{[5] [6]}

d) Explain why she has become oedematous with a rising heart rate, and state the immediate response. (2 marks) ^[6]