Endocrine & metabolic · UKMLA & AKT
Refeeding syndrome
A free high-yield preview for the UKMLA Applied Knowledge Test. Below are the key points to recognise refeeding syndrome — the full SA Note notes add investigations, management, complications and 10 practice questions.
Key high-yield points
- Prolonged starvation depletes intracellular phosphate, potassium, and magnesium - serum levels appear normal as electrolytes redistribute out of breaking-down cells
- Refeeding (oral, enteral, or parenteral) → insulin release → rapid intracellular shift of phosphate, potassium, and magnesium → serum levels collapse → multi-organ dysfunction
- Hypophosphataemia is the hallmark - impairs ATP and 2,3-DPG synthesis → cardiac, respiratory, and neuromuscular failure
- Thiamine (B1) deficiency is unmasked when carbohydrate metabolism resumes - essential cofactor consumed rapidly, causing Wernicke's encephalopathy
A normal pre-feeding serum phosphate does NOT exclude total body depletion - starvation temporarily normalises serum levels by redistributing phosphate out of cells. Risk criteria, not bloods alone, must guide the decision to use a cautious protocol.
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