You are caring for an alcoholic well known to your emergency department. He presents with intoxication. His labs are normal, except for an EtOH level of 400. You monitor him for 8 hours and feed him. As you’re getting ready to discharge him, you get called away to a trauma. You come back 2 hours later and now the patient states he is so weak, he can not move. What is the likely electrolyte abnormality you would discover if you rechecked labs.
The patient is suffering from refeeding syndrome. Even though his initial phosphate level was normal, most hospitals are unable to get an ionized phosphate level. Eating caused a surge in insulin which shifted a likely already low extracelullar phosphate level into cells. Other conditions to be concerned about in this patient include rhabdomyolysis caused by hypophosphatemia