Parenteral nutrition and refeeding syndrome — branching viva

Opening — framing the problem

The examiner begins: a 15-year-old with anorexia nervosa is admitted for refeeding after six weeks of negligible intake and a 15 per cent weight loss, with a body mass index of 15. On day two the phosphate has fallen and she is oedematous. Talk me through your approach. [5]

I would frame this as a high-risk refeeding scenario. The combination of prolonged negligible intake, significant weight loss and a very low body mass index places her at the highest risk of refeeding syndrome. My priorities would be to confirm the risk, to have given thiamine before feeding, to have corrected the phosphate, potassium and magnesium, to start at a conservative calorie level and escalate slowly, and to check the electrolytes at least daily for the first week, because the phosphate fall and the oedema tell me the syndrome is already declaring itself. [5] [6]