110年:內專
A 26-year-old girl of type I diabetes had poor appetite and body weight loss for 3 kg (6%) in recent one month. After admission, she received partial parenteral nutrition due to anorexia and poor oral intake. Hypophosphatemia (0.8 mg/dL) was notcied on the third day of admission . The most likely mechanism for her acute hypophosphatemia is:
AAcute stage of diabetic ketoacidosis。
BHungry bone syndrome。
CPrimary hypoparathyroidism。
DRenal phosphate wasting。
EShift of phosphorus into intracellular stores。
詳細解析
本題觀念：
重啟營養後的Refeeding Syndrome會因胰島素大量分泌，驅動葡萄糖與電解質（磷、鉀、鎂）進入細胞，供給ATP及2,3-DPG合成，導致血中磷急速下降，出現低磷血症。此低磷變化常在開始餵食後2–5天內發生。 (pmc.ncbi.nlm.nih.gov, ncbi.nlm.nih.gov) (ncbi.nlm.nih.gov)
選項分析
- 選項A：急性DKA階段。未治療前的DKA患者血磷通常正常或偏高，只有在insulin治療時才會發生細胞內移位並導致低磷；本題無提及DKA治療情境，且時間點不符。 ([pmc.ncbi.nlm.nih.gov](https://pmc.ncbi.nlm.nih.gov/articles/PMC3047968/?utm_source=ch
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