Nutritional assessment methods US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Nutritional assessment methods. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Nutritional assessment methods US Medical PG Question 1: An investigator is measuring the blood calcium level in a sample of female cross country runners and a control group of sedentary females. If she would like to compare the means of the two groups, which statistical test should she use?
- A. Chi-square test
- B. Linear regression
- C. t-test (Correct Answer)
- D. ANOVA (Analysis of Variance)
- E. F-test
Nutritional assessment methods Explanation: ***t-test***
- A **t-test** is appropriate for comparing the means of two independent groups, such as the blood calcium levels between runners and sedentary females.
- It assesses whether the observed difference between the two sample means is statistically significant or occurred by chance.
*Chi-square test*
- The **chi-square test** is used to analyze categorical data to determine if there is a significant association between two variables.
- It is not suitable for comparing continuous variables like blood calcium levels.
*Linear regression*
- **Linear regression** is used to model the relationship between a dependent variable (outcome) and one or more independent variables (predictors).
- It aims to predict the value of a variable based on the value of another, rather than comparing means between groups.
*ANOVA (Analysis of Variance)*
- **ANOVA** is used to compare the means of **three or more independent groups**.
- Since there are only two groups being compared in this scenario, a t-test is more specific and appropriate.
*F-test*
- The **F-test** is primarily used to compare the variances of two populations or to assess the overall significance of a regression model.
- While it is the basis for ANOVA, it is not the direct test for comparing the means of two groups.
Nutritional assessment methods US Medical PG Question 2: An 11-month-old boy is brought to a pediatrician by his parents for evaluation of vomiting and watery diarrhea over the last day. The mother informs the pediatrician that the boy had consumed an apple bought from a fruit vendor on the previous day, but that otherwise there has been no recent change in his diet. There is no history of blood in the stool, flatulence, irritability, or poor appetite. There is no history of recurrent or chronic diarrhea or any other gastrointestinal symptoms. On physical examination, his temperature is 37.6°C (99.6°F), pulse is 120/min, respirations are 24/min, and blood pressure is 92/60 mm Hg. General examination reveals a playful infant with normal skin turgor and no sunken eyes. The pediatrician explains to the parents that he most likely has acute gastroenteritis and that no specific medication is indicated at present. He also instructs the parents about his diet during the illness and reviews the danger signs of dehydration. He suggests a follow-up evaluation after 48 hours or earlier if any complications arise. Which of the following dietary recommendations did the pediatrician make?
- A. Plenty of juices and carbonated sodas
- B. Age-appropriate diet (Correct Answer)
- C. Diluted formula milk
- D. Lactose-free diet
- E. BRAT diet
Nutritional assessment methods Explanation: ***Age-appropriate diet***
- For **mild acute gastroenteritis** without significant dehydration, the latest recommendations advise continuing **age-appropriate feeding** to support nutritional requirements and promote gut recovery.
- This approach helps to prevent malnutrition and does not prolong the course of diarrhea.
*Plenty of juices and carbonated sodas*
- **High sugar content** in juices and sodas can worsen diarrhea due to their **osmotic effect**, drawing more water into the intestine.
- These beverages also lack essential **electrolytes** needed for rehydration.
*Diluted formula milk*
- Diluting formula can lead to **insufficient caloric intake** and nutritional deficiencies, which is generally not recommended for mild gastroenteritis.
- Undiluted formula is usually well-tolerated, as most infants with acute gastroenteritis do not develop significant **lactose intolerance**.
*Lactose-free diet*
- Routine use of **lactose-free diets** is generally not recommended unless there is strong evidence of **secondary lactase deficiency**, which typically presents with increased flatulence, bloating, and worsening diarrhea.
- The majority of children with acute gastroenteritis can tolerate their usual milk intake.
*BRAT diet*
- The **B**ananas, **R**ice, **A**pplesauce, **T**oast (BRAT) diet is **nutritionally restrictive**, providing inadequate protein and fat, which can hinder recovery and growth in infants.
- Current guidelines no longer recommend the BRAT diet for acute gastroenteritis.
Nutritional assessment methods US Medical PG Question 3: Study X examined the relationship between coffee consumption and lung cancer. The authors of Study X retrospectively reviewed patients' reported coffee consumption and found that drinking greater than 6 cups of coffee per day was associated with an increased risk of developing lung cancer. However, Study X was criticized by the authors of Study Y. Study Y showed that increased coffee consumption was associated with smoking. What type of bias affected Study X, and what study design is geared to reduce the chance of that bias?
- A. Observer bias; double blind analysis
- B. Selection bias; randomization
- C. Lead time bias; placebo
- D. Measurement bias; blinding
- E. Confounding; randomization (Correct Answer)
Nutritional assessment methods Explanation: ***Confounding; randomization***
- Study Y suggests that **smoking** is a **confounding variable** because it is associated with both increased coffee consumption (exposure) and increased risk of lung cancer (outcome), distorting the apparent relationship between coffee and lung cancer.
- **Randomization** in experimental studies (such as randomized controlled trials) helps reduce confounding by ensuring that known and unknown confounding factors are evenly distributed among study groups.
- In observational studies where randomization is not possible, confounding can be addressed through **stratification**, **matching**, or **multivariable adjustment** during analysis.
*Observer bias; double blind analysis*
- **Observer bias** occurs when researchers' beliefs or expectations influence the study outcome, which is not the primary issue described here regarding the relationship between coffee, smoking, and lung cancer.
- **Double-blind analysis** is a method to mitigate observer bias by ensuring neither participants nor researchers know who is in the control or experimental groups.
*Selection bias; randomization*
- **Selection bias** happens when the study population is not representative of the target population, leading to inaccurate results, which is not directly indicated by the interaction between coffee and smoking.
- While **randomization** is used to reduce selection bias by creating comparable groups, the core problem identified in Study X is confounding, not flawed participant selection.
*Lead time bias; placebo*
- **Lead time bias** occurs in screening programs when early detection without improved outcomes makes survival appear longer, an issue unrelated to the described association between coffee, smoking, and lung cancer.
- A **placebo** is an inactive treatment used in clinical trials to control for psychological effects, and its relevance here is limited to treatment intervention studies.
*Measurement bias; blinding*
- **Measurement bias** arises from systematic errors in data collection, such as inaccurate patient reporting of coffee consumption, but the main criticism from Study Y points to a third variable (smoking) affecting the association, not just flawed measurement.
- **Blinding** helps reduce measurement bias by preventing participants or researchers from knowing group assignments, thus minimizing conscious or unconscious influences on data collection.
Nutritional assessment methods US Medical PG Question 4: A 24-year-old man presents to the emergency department complaining of a prolonged course of diarrhea. He reports that he has had 3–4 large volume watery stools daily for the last several weeks. He has no pain with bowel movements, no abdominal pain, and no blood in his stools. He is homeless and uses recreational drugs. He also reports that he usually drinks a half-liter of whiskey, or whatever else he can find, every day and he has done this for several years. The physical exam is notable for a hyperpigmented rash across his face, neck, chest, and the backs of his hands and forearms. On mental status exam, he is oriented to person and place but not time; he scores a 23/30 on the Montreal Cognitive Assessment (MOCA). This patient's presentation is most likely related to which of the following micronutrients?
- A. Vitamin B2
- B. Vitamin B12
- C. Vitamin D
- D. Vitamin C
- E. Vitamin B3 (Correct Answer)
Nutritional assessment methods Explanation: ***Vitamin B3***
- The patient's symptoms—diarrhea, dermatitis (hyperpigmented rash), and dementia (disorientation to time, MOCA 23/30)—are the classic **3 Ds of pellagra**, which is caused by a **vitamin B3 (niacin) deficiency**.
- His chronic alcohol use and poor nutritional status (homelessness, recreational drug use) put him at high risk for such a deficiency, as alcohol impairs nutrient absorption and niacin is often lacking in the diets of those with limited food access.
*Vitamin B2*
- Deficiency in **vitamin B2 (riboflavin)** typically presents with cheilosis, angular stomatitis, glossitis, seborrheic dermatitis, and ocular symptoms like corneal vascularization, none of which are specifically mentioned here.
- While chronic alcohol use can also cause riboflavin deficiency, the patient's full symptom complex points more strongly to pellagra.
*Vitamin B12*
- **Vitamin B12 deficiency** often leads to **macrocytic anemia**, neurological symptoms including peripheral neuropathy, ataxia, and cognitive impairment, and glossitis, but it does not typically cause the characteristic dermatologic rash or diarrhea seen in this patient.
- While chronic alcohol use is a risk factor, the specific triad of diarrhea, dermatitis, and dementia is not consistent with B12 deficiency.
*Vitamin D*
- **Vitamin D deficiency** is associated with bone health issues (rickets in children, osteomalacia in adults), muscle weakness, and in severe cases, hypocalcemia.
- It does not present with the specific combination of diarrhea, hyperpigmented rash, and cognitive changes described in the patient.
*Vitamin C*
- **Vitamin C deficiency (scurvy)** typically manifests as perifollicular hyperkeratosis, bleeding gums, petechiae, impaired wound healing, and musculoskeletal pain.
- While malnourishment and alcohol abuse increase the risk of scurvy, the patient's symptoms do not align with the classic presentation of vitamin C deficiency.
Nutritional assessment methods US Medical PG Question 5: A 19-year-old woman with a known history of malabsorption presents with a painful red tongue, red eyes, and cracked lips. She says her symptoms gradually began 4 months ago after moving away from home for college. She also complains of photophobia, spontaneous lacrimation, and itchy dermatitis. Past medical history is significant for a long-standing malabsorption syndrome, which she says that she hasn't been able to maintain her normal diet or take her vitamins regularly due to her busy schedule. The patient is afebrile and vital signs are within normal limits. On physical examination, she has a malnourished appearance with significant pallor. Conjunctival injection is present bilaterally. Which of the following diagnostic tests will be most helpful to support the diagnosis of the most likely vitamin deficiency in this patient?
- A. Measurement of erythrocyte folate levels
- B. Measurement of erythrocyte glutathione reductase activity (Correct Answer)
- C. Measurement of erythrocyte glutamic oxaloacetic transaminase activity
- D. Measurement of erythrocyte transketolase activity
- E. Measurement of serum methylmalonic acid levels
Nutritional assessment methods Explanation: ***Measurement of erythrocyte glutathione reductase activity***
- This measures the activity of an enzyme that requires **flavin adenine dinucleotide (FAD)**, a coenzyme derived from **riboflavin (vitamin B2)**. Reduced activity, especially after FAD stimulation, suggests **riboflavin deficiency**.
- The patient's symptoms (painful red tongue, red eyes, cracked lips, photophobia, spontaneous lacrimation, itchy dermatitis) are classic manifestations of **ariboflavinosis**, exacerbated by her history of malabsorption and poor dietary intake.
*Measurement of erythrocyte folate levels*
- This test is used to diagnose **folate (vitamin B9) deficiency**, which can cause **macrocytic anemia** and megaloblastic changes.
- While malabsorption can lead to folate deficiency, the patient's specific constellation of symptoms (cheilosis, glossitis, angular stomatitis, ocular symptoms) is more indicative of **riboflavin deficiency**, not folate.
*Measurement of erythrocyte glutamic oxaloacetic transaminase activity*
- This (also known as AST or Aspartate Aminotransferase) enzyme requires **pyridoxal phosphate (vitamin B6)** as a coenzyme. Measurement of its activity, particularly with and without B6 supplementation, can assess **vitamin B6 status**.
- While B6 deficiency can present with dermatitis and glossitis, the prominent ocular symptoms and cheilosis point more strongly towards **riboflavin deficiency**.
*Measurement of erythrocyte transketolase activity*
- This test assesses **thiamine (vitamin B1) status**, as transketolase requires **thiamine pyrophosphate (TPP)** as a cofactor. Reduced activity, especially after TPP stimulation, indicates **thiamine deficiency (beri-beri)**.
- Thiamine deficiency typically presents with neurological symptoms (dry beri-beri) or cardiovascular symptoms (wet beri-beri), which are not described in this patient's presentation.
*Measurement of serum methylmalonic acid levels*
- Elevated **methylmalonic acid (MMA)** levels in serum are a highly sensitive and specific indicator of **vitamin B12 deficiency**, as B12 is essential for the conversion of MMA to succinyl CoA.
- While vitamin B12 deficiency can cause glossitis and neurological symptoms, the patient's specific ocular and dermatological findings are not characteristic of B12 deficiency.
Nutritional assessment methods US Medical PG Question 6: A concerned mother presents to clinic stating that her 14-year-old son has not gone through his growth spurt. She states that, although shorter, he had been growing at the same rate as his peers until the past year. There is no evidence of delayed puberty in the mother, but the father's history is unknown. The patient has no complaints. On physical exam, the patient is a healthy-appearing 14-year-old boy whose height is below the third percentile and whose weight is at the 50th percentile. His bone age is determined to be 11 years. A laboratory workup, including thyroid stimulating hormone (TSH), is unremarkable. What is the most likely diagnosis?
- A. Hypothyroidism
- B. Familial short stature
- C. Constitutional growth delay (Correct Answer)
- D. Growth hormone deficiency
- E. Celiac disease
Nutritional assessment methods Explanation: ***Constitutional growth delay***
- This condition is characterized by **delayed bone age**, normal growth velocity initially followed by a deceleration, and an eventual **catch-up growth spurt** leading to normal adult height. The patient's history of being shorter than peers but growing at the same rate, followed by a recent slow down, and a bone age of 11 years (compared to his chronological age of 14) strongly indicates this.
- The absence of other symptoms, **unremarkable lab workup** (including TSH), and the fact that he was previously growing at the same rate as peers further supports constitutional growth delay, which is often linked to a family history of delayed puberty, even if the mother's history is negative and the father's is unknown.
*Hypothyroidism*
- **Hypothyroidism** would typically present with symptoms such as fatigue, weight gain, constipation, and cold intolerance, none of which are mentioned in the patient's history.
- The **unremarkable TSH** level rules out hypothyroidism as the cause of growth delay in this case.
*Familial short stature*
- In **familial short stature**, children typically grow along a short but otherwise normal percentile curve, and their bone age would typically match their chronological age.
- The patient's growth deceleration and significantly **delayed bone age** are inconsistent with familial short stature.
*Growth hormone deficiency*
- **Growth hormone deficiency** often presents with a significant deceleration of growth velocity and very short stature for age, but usually the bone age delay is more pronounced or proportional to the chronological age.
- While low height is present, the **otherwise healthy appearance** and absence of other metabolic or health issues make constitutional growth delay more likely, especially with the provided bone age and normal lab results.
*Celiac disease*
- **Celiac disease** can cause growth delay, but it would typically be accompanied by gastrointestinal symptoms such as abdominal pain, diarrhea, or malabsorption-related issues like weight loss or anemia.
- This patient is **asymptomatic** and has a normal weight for his height percentiles, which makes celiac disease an unlikely diagnosis.
Nutritional assessment methods US Medical PG Question 7: A 50-year-old man presents to the office for a routine health check-up. Managing his weight has been his focus to improve his overall health. The doctor discusses his weight loss goals and overall health benefits from weight loss, including better blood pressure management and decreased insulin resistance. The national average weight for males aged 50-59 years old is 90 kg (200 lb) with a standard deviation of 27 kg (60 lb). What would be the most likely expected value if his weight was 2 standard deviations above the mean?
- A. 36 kg (80 lb)
- B. 63 kg (140 lb)
- C. 172 kg (380 lb)
- D. 144 kg (320 lb) (Correct Answer)
- E. 118 kg (260 lb)
Nutritional assessment methods Explanation: ***144 kg (320 lb)***
- To find a weight 2 standard deviations above the mean, you use the formula: **mean + (2 × standard deviation)**.
- Given a mean of 90 kg and a standard deviation of 27 kg, the calculation is 90 + (2 × 27) = 90 + 54 = **144 kg**. In pounds: 200 lb + (2 × 60 lb) = 200 + 120 = **320 lb**.
*36 kg (80 lb)*
- This value is significantly below the mean and represents a weight **2 standard deviations below the mean**, not above it.
- Calculation: 90 - (2 × 27) = 90 - 54 = 36 kg.
*63 kg (140 lb)*
- This value is **below the mean** and represents a weight approximately **1 standard deviation below the mean**, not above.
- Calculation: 90 - 27 = 63 kg.
*172 kg (380 lb)*
- This value is **too high** for 2 standard deviations above the mean and would represent a weight closer to **3 standard deviations above the mean**.
- Calculation: 90 + (3 × 27) = 90 + 81 = 171 kg (approximately 172 kg).
*118 kg (260 lb)*
- This value represents a weight approximately **1 standard deviation above the mean**, not 2.
- Calculation: 90 + 27 = 117 kg (approximately 118 kg or 260 lb).
Nutritional assessment methods US Medical PG Question 8: A 14-year-old girl is brought to the physician for evaluation of her short stature. She was born at term, and her birth length was normal. She has not yet attained menarche. Her mother is 162 cm (5 ft 4 in) tall and her father is 177 cm (5 ft 10 in) tall. She is at the 3rd percentile for height and 40th percentile for weight. Vital signs are within normal limits. Breast and pubic hair development are Tanner stage 2. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?
- A. Measurement of serum thyroid-stimulating hormone concentration
- B. Measurement of serum insulin-like growth factor concentration
- C. Genetic karyotyping
- D. X-ray of the hand and wrist (Correct Answer)
- E. MRI of the brain
Nutritional assessment methods Explanation: ***X-ray of the hand and wrist***
- An **X-ray of the hand and wrist** is used to determine **bone age**, which is crucial for evaluating short stature by comparing skeletal maturity to chronological age.
- In a 14-year-old girl with short stature and delayed puberty (Tanner stage 2, no menarche), a **delayed bone age** would suggest a constitutional growth delay, which is a common cause of short stature.
*Measurement of serum thyroid-stimulating hormone concentration*
- While **hypothyroidism** can cause short stature and delayed puberty, there are no other clinical signs (e.g., fatigue, weight gain, cold intolerance) to strongly suggest this diagnosis in this patient.
- A TSH measurement would typically be considered after initial screening tests, or if other symptoms are present.
*Measurement of serum insulin-like growth factor concentration*
- **Insulin-like growth factor 1 (IGF-1)** is used to screen for **growth hormone deficiency**, but this is usually evaluated after bone age assessment.
- Growth hormone deficiency is less likely without other symptoms or a clear growth curve deceleration.
*Genetic karyotyping*
- **Genetic karyotyping** is indicated if **Turner syndrome** (XO karyotype) is suspected, which could cause short stature and primary amenorrhea.
- However, the patient's normal birth length and lack of characteristic dysmorphic features make it a less immediate first step compared to bone age assessment.
*MRI of the brain*
- An **MRI of the brain** would be considered if there was suspicion of a **pituitary or hypothalamic tumor** causing growth hormone deficiency or delayed puberty.
- There are no specific neurological symptoms or signs of increased intracranial pressure to warrant a brain MRI as the initial diagnostic step in this case.
Nutritional assessment methods US Medical PG Question 9: One week after undergoing sigmoidectomy with end colostomy for complicated diverticulitis, a 67-year-old man has upper abdominal pain. During the surgery, he was transfused two units of packed red blood cells. His postoperative course was uncomplicated. Two days ago, he developed fever. He is currently receiving parenteral nutrition through a central venous catheter. He has type 2 diabetes mellitus, hypertension, and hypercholesterolemia. He is oriented to person, but not to place and time. Prior to admission, his medications included metformin, valsartan, aspirin, and atorvastatin. His temperature is 38.9°C (102.0°F), pulse is 120/min, and blood pressure is 100/60 mmHg. Examination shows jaundice of the conjunctivae. Abdominal examination shows tenderness to palpation in the right upper quadrant. There is no rebound tenderness or guarding; bowel sounds are hypoactive. Laboratory studies show:
Leukocytes 13,500 /mm3
Segmented neutrophils 75 %
Serum
Aspartate aminotransferase 140 IU/L
Alanine aminotransferase 85 IU/L
Alkaline phosphatase 150 IU/L
Bilirubin
Total 2.1 mg/dL
Direct 1.3 mg/dL
Amylase 20 IU/L
Which of the following is the most likely diagnosis in this patient?
- A. Acute pancreatitis
- B. Small bowel obstruction
- C. Hemolytic transfusion reaction
- D. Anastomotic insufficiency
- E. Acalculous cholecystitis (Correct Answer)
Nutritional assessment methods Explanation: ***Acalculous cholecystitis***
* This patient's clinical picture, including fever, **right upper quadrant tenderness**, **jaundice**, and elevated **liver enzymes** (AST, ALT, ALP, bilirubin), following a major abdominal surgery and **central venous parenteral nutrition**, is highly suggestive of acalculous cholecystitis.
* **Acalculous cholecystitis** often affects critically ill patients, especially those with trauma, burns, sepsis, or prolonged parenteral nutrition, due to gallbladder stasis and ischemia, even in the absence of gallstones.
*Acute pancreatitis*
* While the patient has upper abdominal pain, the **amylase level is normal** (20 IU/L), which rules out acute pancreatitis.
* **Acute pancreatitis** typically presents with severe epigastric pain radiating to the back and a significant elevation in amylase and lipase levels (usually 3 times the upper limit of normal).
*Small bowel obstruction*
* Symptoms of small bowel obstruction usually include **abdominal distension**, **crampy abdominal pain**, **vomiting**, and **absence of flatus/bowel movements**, along with characteristic findings on imaging.
* Although bowel sounds are hypoactive and the patient had surgery, the predominant features here (fever, jaundice, RUQ tenderness, elevated liver enzymes) point away from obstruction and more towards an inflammatory process involving the liver/biliary system.
*Hemolytic transfusion reaction*
* A **hemolytic transfusion reaction** would cause fever, chills, hemoglobinuria, flank pain, and jaundice, but would occur soon after the transfusion (within hours for acute reactions) and typically present with signs of acute kidney injury and disseminated intravascular coagulation, which are not described.
* The time frame (one week post-transfusion) and the localized right upper quadrant tenderness with liver enzyme elevations make this less likely.
*Anastomotic insufficiency*
* An **anastomotic leak** would typically present with severe abdominal pain, peritonitis (rebound tenderness, guarding), fever, and sepsis, often leading to abscess formation.
* This patient's examination **lacks rebound tenderness or guarding**, and the predominant findings of jaundice and elevated liver enzymes are not the primary features of an anastomotic leak.
Nutritional assessment methods US Medical PG Question 10: A 69-year-old man is brought to the emergency room by his daughter due to confusion. She reports that her father did not remember who she was yesterday, and his refrigerator was completely empty when she tried to make him lunch. She states that he was acting like himself when she visited him last week. She also notes that he has struggled with alcoholism for many years and has not seen a doctor in over two decades. She is unsure if he has any other chronic medical conditions. In the emergency room, the patient’s temperature is 101.2°F (38.4°C), pulse is 103/min, respirations are 22/min, and O2 saturation is 92% on room air. His BMI is 17.1 kg/m^2. Physical exam reveals an extremely thin and frail man who is not oriented to person, place, or time. As he is being examined, he becomes unresponsive and desaturates to 84%. He is intubated and admitted to the intensive care unit for what is found to be pneumonia, and the patient is started on total parental nutrition as he is sedated and has a history of aspiration from a prior hospitalization. Two days later, physical exam is notable for new peripheral edema. Laboratory tests at that time reveal the following:
Serum:
Na+: 133 mEq/L
Cl-: 101 mEq/L
K+: 2.4 mEq/L
HCO3-: 24 mEq/L
BUN: 22 mg/dL
Glucose: 124 mg/dL
Creatinine: 1.1 mg/dL
Phosphate: 1.1 mg/dL
Mg2+: 1.0 mg/dL
Which of the following could have prevented the complication seen in this patient?
- A. Initiation of furosemide
- B. Use of low-sugar TPN
- C. Use of enteral nutrition
- D. Initiation of intermittent dialysis
- E. Slow initiation of total parenteral nutrition (TPN) (Correct Answer)
Nutritional assessment methods Explanation: ***Slow initiation of total parenteral nutrition (TPN)***
- This patient likely developed **refeeding syndrome**, which is characterized by severe electrolyte shifts (especially **hypophosphatemia**, **hypokalemia**, and **hypomagnesemia**) and fluid retention (peripheral edema) upon rapid reintroduction of nutrition to severely malnourished individuals.
- A **slow and gradual introduction of TPN** would have allowed the body to adapt to the increased metabolic demands, preventing the sudden intracellular shift of electrolytes and subsequent depletion in the serum.
*Initiation of furosemide*
- Furosemide is a **loop diuretic** primarily used to treat fluid overload and edema by increasing renal excretion of water and electrolytes.
- While it could address the peripheral edema, it would not correct the underlying electrolyte imbalances of refeeding syndrome and could potentially worsen them (e.g., contributing to **hypokalemia**).
*Use of low-sugar TPN*
- Refeeding syndrome is triggered by the shift from fat metabolism to carbohydrate metabolism, leading to increased insulin secretion and subsequent intracellular movement of electrolytes.
- While a lower glucose load might slightly mitigate the insulin response, it does not address the core issue of rapid nutrient repletion in a severely malnourished state, and the absolute amount of carbohydrates would still be significant in TPN.
*Use of enteral nutrition*
- **Enteral nutrition** (feeding via the gastrointestinal tract) is generally preferred over TPN when feasible, as it helps maintain gut integrity and has a lower risk of certain complications.
- However, if initiated too rapidly in a severely malnourished patient, enteral nutrition can also precipitate refeeding syndrome, as the metabolic shifts are triggered by carbohydrate repletion regardless of the delivery route.
*Initiation of intermittent dialysis*
- **Intermittent dialysis** is a renal replacement therapy used for acute or chronic kidney failure to remove waste products and excess fluid.
- This patient's creatinine and BUN are only mildly elevated for someone with pneumonia and dehydration, indicating **no clear indication for dialysis**; phosphorus and magnesium could be corrected with supplementation.
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