A severely malnourished 40-year-old man with chronic intestinal obstruction is started on aggressive parenteral nutrition. On day 2 he develops paraesthesiae, confusion, and ventricular ectopy. Which electrolyte disturbance is the hallmark of this complication?
- A Hypophosphataemia ✓
- B Hyponatraemia
- C Hyperkalaemia
- D Hypercalcaemia
Correct answer: A. Hypophosphataemia
Explanation
Refeeding syndrome follows rapid reintroduction of carbohydrate in a starved patient. The insulin surge drives phosphate, potassium and magnesium into cells, and hypophosphataemia is the defining biochemical feature, producing cardiac arrhythmia, respiratory failure, haemolysis and neurological dysfunction. Prevention is gradual caloric advancement with thiamine supplementation and close monitoring of phosphate, potassium and magnesium in the first few days. Hyperkalaemia and hypercalcaemia do not occur; serum potassium and magnesium typically fall along with phosphate.
Reference: Schwartz's Principles of Surgery, 11th ed.
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