A patient receiving Total Parenteral Nutrition (TPN) in the ICU develops sudden onset of confusion, tachycardia, and muscle weakness 48 hours after refeeding. Lab results show: K^+ = 2.8 text mEq/L , PO_4^ 3- = 0.4 text mmol/L , Mg^ 2+ = 0.6 text mmol/L . What syndrome is occurring?

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Nursing QUESTION #9240

Question 1

A patient receiving Total Parenteral Nutrition (TPN) in the ICU develops sudden onset of confusion, tachycardia, and muscle weakness 48 hours after refeeding. Lab results show: K\(^+ = 2.8 \text{ mEq/L}\), PO\(_4^{3-} = 0.4 \text{ mmol/L}\), Mg\(^{2+} = 0.6 \text{ mmol/L}\). What syndrome is occurring?

Hyperglycemic hyperosmolar state
Refeeding syndrome✔️
Wernicke's encephalopathy
Central pontine myelinolysis

Correct Answer Explanation

Correct Answer: B — Refeeding Syndrome

Refeeding Syndrome occurs when nutrition (especially carbohydrates) is reintroduced after prolonged starvation. The sudden increase in insulin drives intracellular shift of electrolytes, causing:

Electrolyte	Change	Normal Range	Consequence
Phosphate (PO\(_4^{3-}\))	↓ Critical	\(0.8 - 1.5 \text{ mmol/L}\)	Respiratory failure, hemolysis, cardiac arrest
Potassium (K\(^+\))	↓ Hypokalemia	\(3.5 - 5.0 \text{ mEq/L}\)	Arrhythmias, muscle weakness
Magnesium (Mg\(^{2+}\))	↓ Hypomagnesemia	\(0.8 - 1.0 \text{ mmol/L}\)	Arrhythmias, seizures, neuromuscular excitability

Prevention: Start TPN slowly, correct electrolytes before refeeding, monitor daily, supplement thiamine (vitamin B1) prophylactically.

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