Vitamins and minerals: refeeding syndrome: practice question

A Biochemistry 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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Biochemistry · Vitamins and minerals: refeeding syndrome

Sample item

A severely malnourished 24-year-old woman with anorexia nervosa is started on aggressive enteral feeding. On day 3 she develops muscle weakness, an arrhythmia and confusion. Which laboratory pattern is most expected?

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

The answer and the reasoning

B. Low phosphate with low potassium and low magnesium

Carbohydrate refeeding raises insulin, which drives phosphate, potassium and magnesium into cells and increases phosphorylation reactions that consume phosphate. Serum levels fall sharply, producing weakness, arrhythmias, respiratory failure and confusion. Thiamine is also given because glucose loading can precipitate Wernicke encephalopathy.

Option by option

  • A. High sodium with low chloride and raised bicarbonate

    This pattern is not produced by refeeding; electrolytes fall rather than sodium rising.

  • B. Low phosphate with low potassium and low magnesium (correct)

    Correct. Insulin-driven cellular uptake and ATP synthesis deplete serum phosphate, potassium and magnesium.

  • C. High phosphate with high potassium and high magnesium

    These ions fall in refeeding syndrome; high levels would suggest renal failure or cell lysis.

  • D. Low calcium with high phosphate and raised creatinine

    This pattern fits chronic kidney disease, not the shift caused by refeeding.

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 Biochemistry question

What is the answer to this Biochemistry question?

The best answer is B, Low phosphate with low potassium and low magnesium. Carbohydrate refeeding raises insulin, which drives phosphate, potassium and magnesium into cells and increases phosphorylation reactions that consume phosphate.

Why is "High sodium with low chloride and raised bicarbonate" not the answer?

This pattern is not produced by refeeding; electrolytes fall rather than sodium rising.

Why is "High phosphate with high potassium and high magnesium" not the answer?

These ions fall in refeeding syndrome; high levels would suggest renal failure or cell lysis.

Why is "Low calcium with high phosphate and raised creatinine" not the answer?

This pattern fits chronic kidney disease, not the shift caused by refeeding.

What concept does this question test?

It tests Vitamins and minerals: refeeding syndrome in Biochemistry. Serum levels fall sharply, producing weakness, arrhythmias, respiratory failure and confusion. Thiamine is also given because glucose loading can precipitate Wernicke encephalopathy.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Vitamins and minerals: refeeding syndrome?

Build one table of enzyme deficiency, disease, inheritance and key finding, then revise it by spaced recall. Then use the flashcards and the other Biochemistry 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.