UPSC-CMS 2019 — General Medicine

Q: Refeeding syndrome seen after enteral or parenteral nutrition is characterized by all EXCEPT:

Hyponatremia. ***Hyponatremia*** - **Hyponatremia** is not a characteristic feature of refeeding syndrome; rather, fluid retention can sometimes lead to dilutional hyponatremia, but it's not a direct electrolyte shift caused by refeeding. - The core biochemical derangements in refeeding syndrome involve shifts of potassium, magnesium, and phosphate intracellularly [1]. *Hypomagnesemia* - **Hypomagnesemia** is a common and characteristic feature of refeeding syndrome as magnesium is required for ATP generation and cell growth, leading to intracellular shift [1]. - This can contribute to various symptoms such as arrhythmias, weakness, and altered mental status. *Hypocalcemia* - While less direct than other electrolyte disturbances, **hypocalcemia** can occur in refeeding syndrome, partly due to the association with hypophosphatemia and hypomagnesemia. - It may also be exacerbated by vitamin D deficiency or increased parathyroid hormone resistance in malnourished states. *Hypophosphatemia* - **Hypophosphatemia** is the biochemical hallmark of refeeding syndrome, as phosphate is rapidly taken up by cells for ATP synthesis and other metabolic processes during refeeding [1]. - Severe hypophosphatemia can lead to **respiratory failure**, cardiac dysfunction, and rhabdomyolysis. [Practice more General Medicine PYQs on OnCourse]

Q: The capillary refill time is prolonged in all types of shock EXCEPT:

Septic shock. ***Septic shock*** - In **warmed septic shock**, capillary refill time may be **normal or even brisk** due to peripheral vasodilation caused by inflammatory mediators. - While other forms of shock present with decreased peripheral perfusion and prolonged capillary refill, early septic shock can manifest with a **hyperdynamic circulation**. *Obstructive shock* - This type of shock, often due to conditions like **tension pneumothorax** or **cardiac tamponade**, leads to reduced cardiac output and poor peripheral perfusion. - Reduced peripheral blood flow results in a **prolonged capillary refill time**. *Hypovolemic shock* - Characterized by a significant **loss of circulating blood volume**, leading to reduced cardiac output and vasoconstriction. - This peripheral vasoconstriction directly causes a **prolonged capillary refill time** as blood flow to the capillaries is diminished. *Cardiogenic shock* - Results from **primary heart failure**, leading to decreased cardiac output and systemic hypoperfusion. - The reduced effective circulating volume and compensatory vasoconstriction cause impaired peripheral perfusion, manifesting as a **prolonged capillary refill time**. [Practice more General Medicine PYQs on OnCourse]

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Refeeding syndrome seen after enteral or parenteral nutrition is characterized by all EXCEPT:

The capillary refill time is prolonged in all types of shock EXCEPT: