Case challenge · Nutrition / Critical care / Internal medicine · teaching

Refeeding Syndrome — Management Pathway · case challenge

Given a case, work through the care pathway step by step; the tool checks each choice and scores you. Decisions and basis are taken from this site's reviewed care pathways.

← View the full flowchartBased on NICE / ASPEN

Case #1Nutrition / Critical care / Internal medicine

📋 Case data

High-risk prevention or already occurringHigh-risk, not yet fed

Data is taken from this pathway's reviewed node text. Work through the pathway step by step.

Step 1 / 1 · High-risk prevention or already occurring

High-risk needing prevention, or already with electrolyte disturbance/organ dysfunction?

💡 Restarting feeding after starvation/malnutrition; carbohydrate → insulin surge → intracellular shift of phosphate/potassium/magnesium, hypophosphatemia is the hallmark + low potassium + low magnesium, thiamine depletion → Wernicke, sodium-water retention → fluid overload (usually days 2–5). High-risk (NICE): BMI <16, very little intake for >5–10 days, marked weight loss, low baseline electrolytes. Complications: arrhythmia/sudden death, respiratory muscle weakness, heart failure, rhabdomyolysis.

For teaching. Decisions and their basis are taken from this site's reviewed care pathways; for licensed clinicians/trainees, this does not replace clinical judgment or local protocols.