Perioperative: refeeding syndrome: practice question

A General Surgery 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 Surgery · Perioperative: refeeding syndrome

Sample item

A 30-year-old woman with anorexia nervosa (BMI 13) starts aggressive enteral feeding before surgery. On day 4 she develops weakness, peripheral oedema, arrhythmia and respiratory failure. Which biochemical abnormality is the hallmark?

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

The answer and the reasoning

D. Hypophosphataemia

Reintroducing carbohydrate to a starved patient causes an insulin surge that drives phosphate, potassium and magnesium into cells, and increases thiamine demand. Hypophosphataemia is the hallmark and causes muscle weakness, arrhythmias and respiratory failure, with fluid retention. Prevention is to start feeding slowly, supplement electrolytes and give thiamine.

Option by option

  • A. Hypercalcaemia

    Hypercalcaemia is not part of this syndrome.

  • B. Hypernatraemia

    Hypernatraemia is not the characteristic feature, although sodium and water retention occur.

  • C. Hyperphosphataemia

    Phosphate falls rather than rises, since total body stores are depleted.

  • D. Hypophosphataemia (correct)

    Intracellular shift of phosphate under insulin action causes profound hypophosphataemia.

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 Surgery question

What is the answer to this General Surgery question?

The best answer is D, Hypophosphataemia. Reintroducing carbohydrate to a starved patient causes an insulin surge that drives phosphate, potassium and magnesium into cells, and increases thiamine demand.

Why is "Hypercalcaemia" not the answer?

Hypercalcaemia is not part of this syndrome.

Why is "Hypernatraemia" not the answer?

Hypernatraemia is not the characteristic feature, although sodium and water retention occur.

Why is "Hyperphosphataemia" not the answer?

Phosphate falls rather than rises, since total body stores are depleted.

What concept does this question test?

It tests Perioperative: refeeding syndrome in General Surgery. Hypophosphataemia is the hallmark and causes muscle weakness, arrhythmias and respiratory failure, with fluid retention. Prevention is to start feeding slowly, supplement electrolytes and give thiamine.

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 Perioperative: refeeding syndrome?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.