# 一名嚴重營養不良個案開始TPN。48小時後出現呼吸困難、混亂、虛弱，檢驗顯示磷、鎂、鉀偏低。優先判讀與處置是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391887&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名嚴重營養不良個案開始TPN。48小時後出現呼吸困難、混亂、虛弱，檢驗顯示磷、鎂、鉀偏低。優先判讀與處置是什麼？

## 選項

1. 再餵食症候群：降低熱量負荷，積極補充磷/鎂/鉀，恢復前補充thiamine，並在密切監測下緩慢增加營養 **✔ 正確答案**
2. 停止所有電解質監測
3. 預期的正常反應
4. 提高TPN速率以更快矯正

**正確答案: 1**

## 解析

正確（2）：再餵食症候群是在飢餓後重新給予碳水化合物，胰島素上升使磷、鎂、鉀移入細胞內，造成嚴重缺乏，可能出現心律不整、呼吸衰竭、癲癇、心衰竭。預防方式為TPN從目標25-50%開始，4-7天緩慢增加，初期餵食前/中給thiamine 100 mg，進一步增加前先補足磷/Mg/K。（1,3,4）危險。

## 深入解析

記憶提示 再餵食 =「磷-鎂-鉀下降 + 碳水前先給thiamine」。高風險：BMI 15%、>10天無攝食、餵食前電解質低。

## 臨床情境

情境 65歲女性，嚴重蛋白質-熱量營養不良，開始TPN。48小時後：呼吸困難、混亂、虛弱、phosphate 1.2、Mg 1.3、K 3.0。

## 重要概念

- **再餵食症候群** — 營養不良個案再餵食後，胰島素造成P/Mg/K轉移；可導致致命心律不整/呼吸衰竭。
- **餵食前thiamine補充** — 初期餵食前與期間給thiamine 100-300 mg，以預防Wernicke腦病變。
- **緩慢增加營養** — 從目標25-50%開始，4-7天增加，並每日監測電解質。

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