A profoundly malnourished patient with obstructing hypopharyngeal cancer has eaten almost nothing for ten days. What is the safest nutritional principle?
Severe starvation creates high refeeding risk. Sudden full-calorie feeding can precipitate hypophosphataemia, cardiac failure and neurological injury; nutrition and tumour treatment require coordinated specialist planning.
A. Give full caloric requirements immediately: Rapid carbohydrate loading can trigger refeeding syndrome.
B. Delay all nutrition until cancer treatment finishes: Ongoing starvation worsens treatment tolerance and risk.
C. Start nutrition cautiously with thiamine, electrolyte correction and close phosphate monitoring: Severe starvation creates high refeeding risk. Sudden full-calorie feeding can precipitate hypophosphataemia, cardiac failure and neurological injury; nutrition and tumour treatment require coordinated specialist planning.
D. Correct sodium only: Phosphate, potassium, magnesium, thiamine and fluid balance are central.
E. Use parenteral nutrition automatically: The safest route depends on gut function and obstruction; route does not remove refeeding risk.
If the patient were well nourished with a short fasting period, standard postoperative feeding advancement could be used.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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