During refeeding in severe anorexia nervosa, which practice is essential?

• A. Rapid caloric increase on day one
• B. Close monitoring of electrolytes and gradual caloric advancement
• C. Withholding all fluids
• D. Avoiding nutrition for the first week

Answer: (B)

Refeeding syndrome risk in severely malnourished patients comes from sudden shifts in electrolytes—especially phosphate, potassium, and magnesium—as calories are reintroduced. This can trigger dangerous complications like arrhythmias, edema, respiratory failure, and neuromuscular problems. The essential practice is to monitor electrolytes closely and advance calories gradually, allowing the body to adapt while you correct any disturbances early. In practice, this also includes addressing vitamin deficiencies (notably thiamine) before or during feeding and careful fluid management to avoid overload. Rapidly increasing calories on day one would heighten refeeding risk, while withholding all fluids or delaying nutrition for a week would worsen the patient's condition and recovery.