In refeeding syndrome, which electrolyte abnormality is the hallmark metabolic derangement and the primary driver of cardiac arrhythmias?

• A Hyponatraemia
• B Hypokalaemia
• C Hypophosphataemia ✓
• D Hypomagnesaemia

Explanation

Refeeding syndrome is characterised by a precipitous fall in serum phosphate when carbohydrates are reintroduced to starved patients, stimulating insulin release and cellular phosphate uptake for ATP synthesis. Severe hypophosphataemia (<0.5 mmol/L) causes cardiac failure, respiratory muscle weakness, haemolysis, and neurological dysfunction. Hypokalaemia and hypomagnesaemia also occur but hypophosphataemia is the hallmark. NICE guidelines recommend phosphate supplementation before and during refeeding.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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