Choose how you want to revise
Revise with my preferences. Choose your difficulty or recap questions you've found hard.
Test myself against recent exam themes and ones curated by BMJ’s editorial team of doctors.
Play under a username and join friends or others for 10 questions. Move up of the daily leaderboard.
On the go
Download the app for offline access. Make revision easily fit into your schedule.
Select the best subscription for your exam date
Join 200,000+ OnExamination users who have successfully become medical professionals
April 2024 Exam
Revise with quality questions and detailed explanations
An 81-year-old frail man was admitted with a stroke and after eight days of being nil by mouth nasogastric feeding is commenced.
Following the commencement of feeding after previous starvation which biochemical abnormality is the most likely cause of his drowsiness?
Key Learning Point
Refeeding syndrome is associated with hypophosphataemia.
The chronology of his presentation eight days after commencing NG feeds suggests hypophosphataemia associated with the refeeding syndrome.
This is well described in elderly frail subjects who may have prior poor nutrition in addition to any period of oral starvation.
Other electrolyte abnormalities are also described in association with NG feeds, for example, hypernatraemia, but with this briefest of histories and the eight days, hypophosphataemia is the most likely.