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Parkinson disease psychosis — ABIM Board MCQ

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HardNeurologyParkinson disease psychosisABIM Board

A severely malnourished patient develops edema, respiratory weakness, and ventricular ectopy 36 hours after full-calorie tube feeding begins. Phosphate is 0.8 mg/dL, potassium 2.9 mEq/L, and magnesium 1.1 mg/dL. What is the most appropriate immediate management?

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Correct answer: C — Reduce calories, administer thiamine, and urgently replace phosphate, potassium, and magnesium

The best answer is “Reduce calories, administer thiamine, and urgently replace phosphate, potassium, and magnesium”. This is clinically significant refeeding syndrome, with insulin-driven intracellular shifts causing profound hypophosphatemia, hypokalemia, hypomagnesemia, fluid retention, respiratory weakness, and arrhythmia. Caloric delivery should be reduced and then advanced cautiously, thiamine provided, and electrolytes urgently replaced with cardiac and biochemical monitoring. Continuing full calories worsens the shifts, whereas prolonged starvation is unnecessary and isolated magnesium replacement or diuresis does not correct phosphate-dependent ATP failure.

Reference: ASPEN Consensus Recommendations for Refeeding Syndrome: https://pubmed.ncbi.nlm.nih.gov/32115791/