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Demo Question

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.

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