Endocrine & metabolic · UKMLA & AKT
Refeeding syndrome
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
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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