A 60-year-old malnourished patient with oesophageal cancer requires nutritional supplementation before oesophagectomy. He weighs 55 kg with a BMI of 17. After initiating parenteral nutrition, on day 2 he develops muscle weakness, cardiac arrhythmia, and serum phosphate of 0.4 mmol/L. What complication has occurred?
- A Central line-associated bloodstream infection
- B Wernicke's encephalopathy
- C Refeeding syndrome ✓
- D Insulin-induced hypoglycaemia
Correct answer: C. Refeeding syndrome
Explanation
Refeeding syndrome occurs when malnourished patients receive rapid nutritional support (enteral or parenteral). Insulin secretion triggered by carbohydrate loading drives phosphate, potassium, and magnesium intracellularly, causing severe hypophosphataemia, arrhythmias, respiratory failure, and death. The NICE criteria identify high-risk patients: BMI <18.5, minimal intake for >5 days, or prior malnourishment. Prevention involves cautious caloric introduction (starting at 10 kcal/kg/day), phosphate/potassium/magnesium supplementation, and thiamine pre-supplementation.
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.