To minimize refeeding syndrome risk, an electrolyte replacement protocol should be started before nutrition therapy begins.

• A. True
• B. False
• C. Only after starting feeding
• D. Not necessary

Answer: (A)

Starting electrolyte replacement before nutrition therapy begins is essential to reduce refeeding syndrome risk. When calories are reintroduced after a period of malnutrition, insulin surges drive phosphate, potassium, and magnesium into cells for carbohydrate and energy production. If serum levels are already depleted, this shift can lead to severe hypophosphatemia, hypokalemia, and hypomagnesemia, with dangerous consequences for cardiac, respiratory, and neuromuscular function. By correcting electrolytes (and providing thiamine) prior to or at the very start of feeding, you create a buffer that helps prevent these abrupt drops as feeding begins. If feeding must start urgently, replete concurrently and monitor closely, adjusting as labs return.