A patient admitted with severe protein-energy malnutrition is started on aggressive total parenteral nutrition (TPN). Three days later he develops hypophosphataemia, hypokalaemia, and cardiac arrhythmias. This is called:

• A Kwashiorkor refeeding
• B Thiamine deficiency precipitated by glucose load
• C Refeeding syndrome ✓
• D Selenium deficiency cardiomyopathy

Explanation

Refeeding syndrome occurs when glucose administration in a malnourished patient triggers insulin release, driving phosphate, potassium, and magnesium into cells; the resulting hypophosphataemia depletes ATP and 2,3-DPG, causing haemolytic anaemia, cardiac failure, respiratory failure, and arrhythmias. Thiamine deficiency (Wernicke's) is a complication of refeeding in alcoholics but is not the cause of the electrolyte shifts. Selenium deficiency is a different entity.

Reference: Harper's Illustrated Biochemistry, 32nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.