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Refeeding syndrome — SCE Acute Medicine MCQ

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EasyAcute Renal and Metabolic EmergenciesRefeeding syndromeSCE Acute Medicine

A 42-year-old man presents with vomiting, weakness, confusion or collapse. Relevant history includes diabetes, kidney disease, endocrine disease or a treatment trigger. On assessment, volume status and bedside physiology are abnormal. Investigations show hypophosphataemia, hypokalaemia and hypomagnesaemia after feeding restart. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Slow feeding and replace phosphate, potassium, magnesium and thiamine

The key discriminator is that hypophosphataemia, hypokalaemia and hypomagnesaemia after feeding restart, which makes Slow feeding and replace phosphate, potassium, magnesium and thiamine the single best answer. Give controlled oxygen and senior review is less appropriate because it does not address the dominant acute risk in the vignette; Give intravenous fluids with reassessment would fit a different presentation or later stage of care. Arrange routine outpatient follow-up and Arrange urgent CT imaging are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE CG32; BNF