# 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.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375092&lang=en  
> language: en  
> subject: Safety and Infection Prevention and Control  
> category: SIPC

## Question

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.

1

Start feeds at full nutritional goal immediately to correct malnutrition rapidly

2

Replete phosphate, potassium, and magnesium before and during early feeds

3

Begin feeds at 5 to 10 kcal/kg/day and advance over 4 to 7 days

4

Administer thiamine 100 to 300 mg IV/PO daily before introducing carbohydrates

5

Monitor electrolytes (PO4, K, Mg, glucose) at least daily during initiation

## 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.

## In-depth explanation

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.

## Clinical scenario

BMI 14, hypothermia, edema. Phosphate 1.6, magnesium 1.4, K 3.2 pre-feed.

## Key concepts

- **refeeding syndrome** — Electrolyte and fluid shifts after reintroducing nutrition in severe malnutrition.
- **thiamine** — Vitamin B1 cofactor for glucose metabolism; given before carbohydrate to prevent Wernicke.
- **hypophosphatemia** — Low serum phosphate; cardinal feature of refeeding causing weakness and arrhythmia.

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