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Refeeding Syndrome — RACP Adult Medicine MCQ

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EasyEndocrinologyRefeeding SyndromeRACP Adult Medicine

A 65-year-old woman admitted for refeeding after prolonged starvation develops confusion, seizure, and cardiac arrhythmia on day 3 of nutritional support. Phosphate is 0.25 mmol/L (critically low), K⁺ 2.8 mmol/L, Mg²⁺ 0.45 mmol/L. What is the most likely syndrome?

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Correct answer: DRefeeding syndrome

Severe hypophosphataemia with hypokalaemia and hypomagnesaemia developing within days of refeeding after starvation is refeeding syndrome. Carbohydrate intake stimulates insulin, driving phosphate, potassium, and magnesium intracellularly. Phosphate depletion causes ATP depletion → cardiac arrhythmias, respiratory failure, seizures, rhabdomyolysis. Prevention: start nutrition slowly (10-20 kcal/kg/day), monitor electrolytes, and replace prophylactically. NICE 2024 criteria identify high-risk patients.

Reference: NICE – 2024 – Refeeding Syndrome; eTG 2024