What should be included in the refeeding syndrome electrolyte replacement protocol?

• A. Replete electrolytes only via intravenous
• B. Replete electrolytes only via feeding tube
• C. Replete all electrolytes via IV, oral, or feeding tube depending on patient condition
• D. Do not replete electrolytes until feeding begins

Answer: (C)

Refeeding syndrome involves insulin-driven shifts that can cause dangerous drops in phosphate, potassium, and magnesium as nutrition is restarted in malnourished patients. To prevent these issues, replenish these electrolytes promptly using the route that fits the patient’s condition: IV when the patient cannot take anything by mouth or via a feeding tube, or oral/enteral when tolerated and feasible. This flexible approach ensures electrolytes are repleted regardless of how nutrition is delivered, and repletion can and should occur alongside the start of refeeding rather than waiting for feeding to begin.