Hypophosphatemia is the most common abnormal laboratory value associated with RFS and is the hallmark of the syndrome. Prolonged malnutrition leads to depletion of intracellular phosphorus, and when a patient is repleted with carbohydrates, increased cellular uptake of phosphorus occurs for generation of high energy phosphate bonds and various enzyme systems, leading to hypophosphatemia.1,2 Insulin release and hyperglycemia also may lead to transcellular shifts of phosphorus, potassium, and magnesium, resulting in hypophosphatemia, hypokalemia, and hypomagnesemia, respectively. Hyperkalemia and hypermagnesemia are not features of RFS. An elevated sedimentation rate is nonspecific and likely related to underlying disease and not RFS.
1. Marinella MA. Refeeding syndrome. In: Frequently overlooked diagnoses in acute care. Philadelphia: Hanley & Belfus; 2003:79-83.
2. Solomon SM, Kirby DF. The refeeding syndrome: a review. JPEN J Parenter Nutr 1990;14:90-7.
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