一位體重僅 35 公斤的17歲女性，因嚴重的神經性厭食症導致有生命危險的營養不良而入院。在歷經數個月的處於飢餓狀態後，治療團隊快速地啟動了積極、高濃度的腸道管灌食以及高熱量 TPN 全靜脈營養。在這種密集營養供應的第三天，病患突然表現出極度嗜睡、腿部嚴重的肌肉無力，且監視器上顯示出頻發性的心室期前收縮 (PVCs, 也就是心律不整)。病患當下正在積極經歷哪一種病理生理危機？
A 17-year-old female weighing 35 kg (77 lbs) is admitted for severe, life-threatening malnutrition secondary to anorexia nervosa. After several months of starvation, the treatment team rapidly initiates aggressive, concentrated enteral feedings and high-caloric TPN. On the third day of this intensive nutrition, the client abruptly exhibits extreme lethargy, profound muscle weakness in her legs, and the monitor demonstrates frequent premature ventricular contractions (PVCs). Which pathophysiological crisis is the client actively experiencing?
- AWernicke-Korsakoff syndrome due to acute thiamine depletion from sudden carbohydrate loads.因突然碳水化合物負荷導致急性硫胺素耗竭之威尼克-柯薩可夫症候群
- BNeuroleptic malignant syndrome triggered as a delayed consequence of psychotropic medications.由精神藥物引發之抗精神病藥惡性症候群
- CDiabetic ketoacidosis provoked by the extreme inability of the starved pancreas to produce insulin.由飢餝胰臟無法產生胰島素所引發之糖尿病酮酸中毒
- DRefeeding syndrome characterized by catastrophic intracellular shifts of phosphorus and potassium.✓ 正解以磷和鉀之災難性細胞內轉移為特徵之再喂食症候群
本題測試飲食障礙症（Eating Disorders）中致死率最高的醫療急症：復食症候群（Refeeding Syndrome）。當處於長期飢餓（慢性碳水化合物耗竭）的脆弱人體突然被灌入大量葡萄糖營養品時，胰島素會出現代償性劇烈激增。這個胰島素海嘯會強行把葡萄糖、大量的磷（Phosphorus）、鉀（Potassium）與鎂（Magnesium）從血液中拽進細胞內。這導致血清內的這三大電解質瞬間災難性崩塌（導致低血磷、低血鉀）。低血磷會導致橫紋肌無力與呼吸肌衰竭；低血鉀則會引發如同本題敘述的心律不整（PVCs）甚至心跳立刻停止。這就是為何對厭食症患者重新進食時，必須謹慎從小劑量開始，絕不可猛烈狂灌（選項D正確）。選項A雖然也是因為碳水化合物引發，但主要是酒精戒斷的腦病變特徵，非肌肉與心血管表現；選項C錯誤，此時胰島素是過度分泌而非無法製造；選項B是使用抗精神病藥物罕見的發燒/肌肉僵硬併發症，與營養補充完全無關。
This question tests the most lethal medical emergency in eating disorders: refeeding syndrome. When a chronically starved, fragile body (with chronic carbohydrate depletion) is suddenly flooded with large amounts of glucose-based nutrition, insulin surges in a compensatory and dramatic fashion. This insulin tsunami forcefully drives glucose, along with large quantities of phosphorus, potassium, and magnesium, from the bloodstream into the cells. The result is a catastrophic, instantaneous collapse of these three key electrolytes in the serum (producing hypophosphatemia and hypokalemia). Hypophosphatemia causes skeletal muscle weakness and respiratory muscle failure; hypokalemia precipitates the dysrhythmias described in this case (PVCs) and can cause immediate cardiac arrest. This is precisely why refeeding in anorexia nervosa must be started cautiously at low doses and must never be initiated aggressively (Option D is correct). Option A, although also related to carbohydrate metabolism, primarily presents as the encephalopathic features of alcohol withdrawal rather than as muscular and cardiovascular manifestations; Option C is incorrect because at this point insulin is being hypersecreted rather than failing to be produced; Option B is a rare febrile/muscle-rigidity complication of antipsychotic use and is unrelated to nutritional repletion.
復食症候群 (Refeeding Syndrome) 在全球營養學界及精神醫學的重症加護病房中皆為頂級威脅，不論台美，對於這類長年絕食抗議或是重度厭食症的女學生，灌食一律要求『Start low, go slow (從底劑量慢慢加)』。