## Refeeding Syndrome in Eating Disorders **Key Point:** Refeeding syndrome is a potentially life-threatening complication that occurs when nutrition is reintroduced to severely malnourished patients, characterized by a shift from catabolic to anabolic metabolism. ### Pathophysiology During prolonged starvation, the body relies on fat and protein catabolism. When feeding resumes, insulin secretion increases, driving glucose, phosphate, and potassium intracellularly for ATP synthesis and anabolic processes. This causes: 1. **Hypophosphatemia** — most critical; phosphate shifts intracellularly for phosphorylation reactions 2. **Hypokalemia** — potassium enters cells for protein synthesis and glycogen storage 3. **Hypomagnesemia** — magnesium depletion parallels potassium loss 4. **Thiamine deficiency** — exacerbates metabolic complications ### Clinical Consequences - Cardiac arrhythmias (from electrolyte shifts) - Rhabdomyolysis - Respiratory failure (from hypophosphatemia-induced weakness) - Seizures - Sudden death **High-Yield:** The triad of **hypophosphatemia + hypokalemia + hypomagnesemia** defines refeeding syndrome. Phosphate is the most sensitive marker. **Clinical Pearl:** Refeeding syndrome can occur in ANY severely malnourished state—not just eating disorders. It is prevented by slow, gradual nutritional rehabilitation with close electrolyte monitoring and thiamine supplementation. **Tip:** In exam questions about eating disorder complications, when you see "refeeding," immediately think **hypophosphatemia** as the cardinal finding.
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