Refeeding syndrome occurs when severely malnourished patients receive aggressive nutritional support. The hallmark biochemical abnormality that drives its clinical manifestations (arrhythmias, respiratory failure, hemolysis) is:
- A Hyponatremia
- B Hypophosphatemia ✓
- C Hypomagnesemia
- D Hypoglycemia
Explanation
Refeeding syndrome is primarily driven by severe hypophosphatemia. When carbohydrates are reintroduced after prolonged starvation, insulin secretion drives phosphate into cells for ATP synthesis (glycolysis, phosphorylation), precipitously lowering serum phosphate. Phosphate depletion impairs: (1) ATP production causing myocardial dysfunction; (2) 2,3-DPG synthesis causing left shift of O2-Hb curve with tissue hypoxia; (3) phospholipid membrane integrity causing hemolysis. Hypokalemia and hypomagnesemia co-occur and contribute to arrhythmias. Prevention involves cautious caloric introduction (maximum 10 kcal/kg/day initially per NICE) with phosphate monitoring and supplementation.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.