Electrolytes: refeeding syndrome: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Electrolytes: refeeding syndrome

Sample item

A severely malnourished 30-year-old with anorexia nervosa is started on full enteral feeding. On day 3 she develops generalised weakness, respiratory muscle weakness and haemolysis. Which biochemical abnormality is the hallmark of this syndrome?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Hypophosphataemia

Carbohydrate feeding raises insulin, which drives phosphate, potassium and magnesium into cells and uses phosphate in glycolysis and ATP synthesis. Serum phosphate falls sharply, causing muscle weakness, haemolysis, arrhythmia and respiratory failure. Thiamine is given before feeding, and feeding is restarted slowly.

Option by option

  • A. Hypernatraemia

    Sodium retention may cause fluid overload, but hypernatraemia is not the hallmark.

  • B. Hyperphosphataemia

    Phosphate falls rather than rises in refeeding.

  • C. Hypophosphataemia (correct)

    Correct. Insulin-driven intracellular shift and ATP synthesis deplete serum phosphate.

  • D. Hypercalcaemia

    Hypercalcaemia is not a feature, and calcium does not shift this way.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Hypophosphataemia. Carbohydrate feeding raises insulin, which drives phosphate, potassium and magnesium into cells and uses phosphate in glycolysis and ATP synthesis.

Why is "Hypernatraemia" not the answer?

Sodium retention may cause fluid overload, but hypernatraemia is not the hallmark.

Why is "Hyperphosphataemia" not the answer?

Phosphate falls rather than rises in refeeding.

Why is "Hypercalcaemia" not the answer?

Hypercalcaemia is not a feature, and calcium does not shift this way.

What concept does this question test?

It tests Electrolytes: refeeding syndrome in General Medicine. Serum phosphate falls sharply, causing muscle weakness, haemolysis, arrhythmia and respiratory failure. Thiamine is given before feeding, and feeding is restarted slowly.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Electrolytes: refeeding syndrome?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.