45-year-old Man in Medicine / Internal Medicine — 45yo Man | Gastroenterology | SMLE Q#1243
SMLE Question #1243
Medicine / Internal Medicine
Gastroenterology
Last updated: February 2026
A 45-year-old man in the ICU is started on high-carbohydrate total parenteral nutrition after 10 days of minimal intake following complicated abdominal surgery. Within 24 hours, he develops generalized weakness, difficulty weaning from mechanical ventilation, and a new generalized tonic-clonic seizure. After stabilization, he has diffuse symmetric muscle weakness without focal neurologic deficits. Other measured electrolytes are within reference range. What is the most likely electrolyte abnormality causing his symptoms?
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