# 嚴重營養不良病人於14天少量進食後開始腸道餵食。降低refeeding症候群風險之行動?複選。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375092&lang=zh-tw  
> language: zh-TW  
> subject: Safety and Infection Prevention and Control  
> category: SIPC

## 題目

嚴重營養不良病人於14天少量進食後開始腸道餵食。降低refeeding症候群風險之行動?複選。

1

立即達到完全營養目標以快速矯正營養不良

2

初期餵食前與期間補充磷、鉀、鎂

3

以5-10 kcal/kg/日起始並於4-7天漸增

4

給予碳水化合物前每日thiamine 100-300 mg IV/PO

5

起始期至少每日監測電解質(PO4、K、Mg、葡萄糖)

## 解析

Refeeding症候群發生於飢餓後再度給予營養:胰島素急升將磷、鉀、鎂推入細胞,血清濃度急降致心律不整、呼吸衰竭、神經惡化。預防:從5-10 kcal/kg/日開始、4-7天漸增、前後補充電解質、給碳水化合物前先thiamine 100-300 mg防Wernicke、第一週每日監測電解質。積極立即達標可能致命。

## 深入解析

最高風險:BMI<16、3-6個月內體重下降>15%、進食極少超過10天、餵食前PO4/K/Mg低。厭食症、酒精使用、減重術後、癌惡病質。

## 臨床情境

BMI 14、低體溫、水腫。餵食前磷1.6、鎂1.4、鉀3.2。

## 重要概念

- **Refeeding症候群** — 嚴重營養不良後再給營養造成電解質與體液移動。
- **Thiamine** — 維生素B1 — 葡萄糖代謝輔因子,給碳水化合物前先給以防Wernicke。
- **低磷血症** — 血清磷低 — refeeding核心,致無力與心律不整。

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