A 55-year-old malnourished patient with Crohn's disease requires bowel resection. Preoperative nutritional assessment reveals severe malnutrition (weight loss 18% over 3 months, BMI 16.5 kg/m², albumin 22 g/L). She is unable to take adequate oral nutrition. According to ESPEN guidelines for preoperative nutritional support, refeeding syndrome risk must be considered when initiating enteral nutrition. Which electrolyte combination is most characteristic of refeeding syndrome?

• A Hyperphosphataemia, hyperkalaemia, hypermagnesaemia
• B Hypophosphataemia with hypercalcaemia and hypernatraemia
• C Hyperkalaemia with metabolic acidosis and hyponatraemia
• D Hypophosphataemia, hypokalaemia, hypomagnesaemia with fluid overload ✓

Explanation

Refeeding syndrome occurs when malnourished patients receive carbohydrate (enteral or parenteral nutrition) — insulin secretion increases, driving glucose, phosphate, potassium, and magnesium intracellularly. The hallmark is hypophosphataemia (phosphate <0.5 mmol/L is severe), accompanied by hypokalaemia and hypomagnesaemia. Concomitant thiamine (B1) depletion can precipitate Wernicke's encephalopathy. Fluid retention (from insulin-mediated sodium and water retention) compounds the problem. NICE guidelines identify risk factors including BMI <16, weight loss >15%, minimal intake for >10 days, and low electrolyte levels pre-feeding. Prevention requires slow refeeding with phosphate supplementation and thiamine before re-feeding.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.