Thiamine supplementation in the prevention of refeeding syndrome is best described as:

• A. Thiamine should be given before and during refeeding to prevent Wernicke's encephalopathy and metabolic complications.
• B. Thiamine is not necessary
• C. Thiamine should be given only after refeeding begins
• D. Thiamine is contraindicated during refeeding

Answer: (A)

When refeeding a malnourished person, the body's demand for thiamine rises because carbohydrate metabolism accelerates as insulin drives glucose into cells. Thiamine is a key cofactor for enzymes that process glucose, and without enough it can lead to metabolic failure and Wernicke's encephalopathy, as well as the electrolyte disturbances seen in refeeding syndrome. Giving thiamine before and during refeeding ensures there is sufficient vitamin available to support the surge in metabolic activity, reducing the risk of serious complications. It isn’t something to delay until after feeding has started, and it isn’t contraindicated or unnecessary.