Refeeding syndrome following aggressive nutritional support after prolonged starvation is characterised by which electrolyte abnormality as the hallmark?
- A Hypernatraemia
- B Hyperkalaemia
- C Hypophosphataemia ✓
- D Hypomagnesaemia
Correct answer: C. Hypophosphataemia
Explanation
Refeeding syndrome is characterised by profound hypophosphataemia as the hallmark electrolyte abnormality. Carbohydrate refeeding triggers insulin release, driving phosphate intracellularly for ATP synthesis from depleted body stores, causing extracellular hypophosphataemia. This leads to cardiac arrhythmias, respiratory failure, haemolytic anaemia, and neuromuscular dysfunction. Thiamine deficiency, hypokalaemia, and hypomagnesaemia co-occur. The NICE risk criteria guide prevention with gradual caloric introduction and prophylactic phosphate/thiamine.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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