A 60-year-old man is ventilated in ICU following major abdominal surgery. He has a nasogastric tube in situ. On day 3 post-op, ileus is resolving. Enteral nutrition is being initiated. Refeeding syndrome is a concern. Which electrolyte abnormality is the HALLMARK of refeeding syndrome and its primary dangerous manifestation?
- A Hyperkalaemia causing peaked T-waves and ventricular fibrillation
- B Hypernatraemia causing cerebral oedema and seizures
- C Hypercalcaemia causing nephrogenic diabetes insipidus
- D Hypophosphataemia, causing respiratory failure, cardiac arrhythmias, and haemolysis ✓
Explanation
Refeeding syndrome occurs when malnourished patients receive carbohydrate, causing insulin release and rapid intracellular shift of phosphate, potassium, and magnesium. Hypophosphataemia is the defining and most dangerous abnormality, causing: respiratory muscle weakness (failure to wean from ventilator), cardiac arrhythmias (including VF), haemolytic anaemia, confusion, and rhabdomyolysis. Risk factors include prolonged starvation, chronic alcoholism, and low pre-feeding phosphate. Prevention involves correcting phosphate/electrolytes before initiating nutrition, initiating feeds slowly, and monitoring electrolytes frequently during the first week.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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