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Refeeding syndrome — SCE Acute Medicine MCQ

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ModerateAcute Renal and Metabolic EmergenciesRefeeding syndromeSCE Acute Medicine

A 50-year-old woman is assessed on the acute medical unit. She is malnourished and develops weakness and arrhythmia after nutrition is restarted. Phosphate is 0.28 mmol/L, potassium and magnesium are low. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: B — Refeeding syndrome

Refeeding syndrome is the best answer because electrolyte shifts after restarting nutrition in a malnourished patient indicate refeeding syndrome. Subarachnoid haemorrhage is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Thiamine and cautious caloric advancement reduce risk.

Reference: https://www.nice.org.uk/guidance/cg32#acute-medicine-order-59-1