A severely malnourished client is to begin enteral feeding after 14 days of minimal intake. Which actions reduce the risk of refeeding syndrome? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Refeeding syndrome arises when nutrition is reintroduced after starvation: insulin surge drives intracellular shift of phosphate, potassium, magnesium causing critically low serum levels, with cardiac arrhythmia, respiratory failure, neurologic decline. Prevention: start low (5-10 kcal/kg/day) and advance over 4-7 days; replete electrolytes BEFORE and during early feeds; thiamine 100-300 mg before carbohydrates to prevent Wernicke; monitor electrolytes daily for 1 week. Aggressive full-goal feeding is contraindicated and can be fatal.
Highest risk: BMI under 16, weight loss over 15 percent in 3-6 months, minimal intake over 10 days, low pre-feed PO4/K/Mg. Anorexia, alcohol use disorder, post-bariatric, oncology cachexia.