A surgeon is planning parenteral nutrition for a postoperative patient. Which of the following is the MOST common and serious metabolic complication of refeeding syndrome?
- A Hypophosphataemia leading to cardiac arrhythmias, respiratory failure, and neurological dysfunction ✓
- B Hyponatraemia due to water retention
- C Hyperkalaemia causing dangerous arrhythmias
- D Hyperglycaemia from carbohydrate excess
Correct answer: A. Hypophosphataemia leading to cardiac arrhythmias, respiratory failure, and neurological dysfunction
Explanation
Refeeding syndrome occurs when malnourished patients are rapidly refed — carbohydrate infusion stimulates insulin release, driving potassium, phosphate, and magnesium intracellularly. Hypophosphataemia is the hallmark and most dangerous derangement, causing cardiac arrhythmias, respiratory muscle weakness (ventilatory failure), haemolytic anaemia, and neurological complications. Prevention involves slow introduction of nutrition (10-20 kcal/kg/day initially) and supplementation of electrolytes before and during refeeding.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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