A surgical patient is unable to tolerate enteral nutrition due to prolonged ileus post-bowel surgery. Parenteral nutrition is initiated. Which electrolyte complication is MOST characteristic of refeeding syndrome during nutritional support?

• A Hyperphosphataemia and hyperkalaemia
• B Hypernatraemia and hyperchloraemia
• C Hypophosphataemia, hypokalaemia, and hypomagnesaemia ✓
• D Hyponatraemia and hypercalcaemia

Explanation

Refeeding syndrome occurs when nutrition (particularly carbohydrates) is reintroduced after a period of starvation. Glucose-driven insulin secretion promotes cellular uptake of phosphate, potassium, and magnesium, causing profound hypophosphataemia (the hallmark), hypokalaemia, and hypomagnesaemia. Hypophosphataemia causes cardiac failure, respiratory failure, haemolytic anaemia, and neuromuscular dysfunction. Thiamine deficiency (also depleted in starvation) should be corrected before starting nutrition (Wernicke's risk). Gradual nutritional replacement and close electrolyte monitoring are essential in high-risk patients.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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