A 19-year-old woman with Anorexia Nervosa (restricting type) is admitted with BMI 13.5 kg/m² and is started on nasogastric feeding. Two days later she develops severe hypophosphataemia, hypokalaemia, and hypomagnesia. The most likely complication being encountered is:

• A Superior mesenteric artery syndrome due to rapid weight gain
• B Refeeding syndrome ✓
• C Hyperglycaemia from carbohydrate loading
• D Oedema from protein repletion

Explanation

Refeeding syndrome is a life-threatening metabolic complication occurring when malnourished individuals are rapidly refed, particularly with carbohydrates. Insulin release drives phosphate, potassium, and magnesium intracellularly, causing severe serum depletion. Hypophosphataemia is the hallmark finding and can cause respiratory muscle weakness, haemolytic anaemia, cardiac failure, and death. Prevention requires gradual caloric reintroduction (10–20 kcal/kg/day initially), electrolyte replacement, and thiamine supplementation before refeeding. Patients with a BMI < 14 or prolonged starvation (> 5 days) are at highest risk.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.