Refeeding syndrome is a potentially fatal complication of recommencing nutrition in severely malnourished patients. The biochemical hallmark and primary driver of refeeding syndrome is:

• A Hypophosphataemia due to intracellular phosphate shift after insulin-driven glucose uptake ✓
• B Hypernatraemia due to salt loading with enteral feeds
• C Hyperglycaemia from sudden carbohydrate load
• D Hyperkalaemia from rapid tissue catabolism

Explanation

Refeeding syndrome occurs when carbohydrates are introduced after prolonged starvation. Insulin release drives glucose, phosphate, potassium, and magnesium into cells. The resulting profound hypophosphataemia is the hallmark and most dangerous abnormality, impairing ATP and 2,3-DPG synthesis and leading to cardiac arrhythmias, respiratory failure, and neurological dysfunction. NICE guidelines recommend starting nutrition at 5–10 kcal/kg/day with careful electrolyte monitoring and replacement before gradual increase over 4–7 days in high-risk patients.

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

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Written and medically reviewed by the StethoPrep medical team.