What is considered a primary precaution during the refeeding syndrome in malnourished patients?

The primary precaution during refeeding syndrome in malnourished patients is the slow introduction of calories. This is crucial because when malnourished individuals are suddenly provided with high levels of carbohydrates and calories, it can lead to severe metabolic disturbances.

Feeding a malnourished person too quickly can cause a rapid influx of glucose that stimulates insulin secretion, leading to a shift of electrolytes, particularly phosphorus, potassium, and magnesium, into the cells. This can result in hypophosphatemia and potentially life-threatening complications such as cardiac arrhythmias, respiratory failure, and even death.

Therefore, it is essential to gradually reintroduce calories, typically starting at 10 kcal/kg/day and slowly increasing over several days. This cautious approach helps to minimize the risk of refeeding syndrome and ensures that the body can adapt to the increased energy supply without compromising electrolyte balance or overall metabolic stability.