An 18-year-old first year college student is admitted to a medical telemetry unit due to a near syncopal episode at the residence hall. The patient has a history of anxiety, obsessive-compulsive disorder & anorexia nervosa. Their body mass index is 16.7 today. Based on lab data, a right subclavian triple lumen catheter is placed to give total parenteral nutrition (TPN). Ninety minutes after the infusion started, the patient reports muscle cramping, headache & visual changes. Based on these findings, the nurse & healthcare team's highest priority is possible

Refeeding syndrome occurs when a malnourished patient is given nutrition (such as TPN), leading to electrolyte imbalances (particularly low phosphorus, potassium, and magnesium) that can cause symptoms like muscle cramping, headache, and visual changes. This condition requires immediate correction of electrolyte imbalances and careful monitoring. Sudden hyperglycemia can occur with TPN, but the symptoms described (muscle cramping, headache, and visual changes) are more consistent with refeeding syndrome. An air embolus is a serious complication but is less likely to be the cause of these symptoms. Acute panic attacks could cause some of the symptoms, but the patient's low BMI and history of anorexia nervosa make refeeding syndrome the more likely cause.