Endocrine Abstracts

Refeeding syndrome can be defined as the potentially fatal shift in fluids and electrolytes that may occur after the reintroduction of feeding after a period of starvation or fasting in malnourished patients. The hallmark characteristic of refeeding syndrome is hypophosphatemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance, changes in glucose, protein and fat metabolism, hypokalemia, hypomagnesemia and thiamine deficiency. The underlying mechanism of this condition rests on the rise of insulin levels caused by refeeding, promoting cellular glucose and phosphorus uptake, leading to a sharp decline in serum phosphorus concentrations. Chronic alcoholics, elderly people, oncologic and anorectic patients are at higher risk of developing this condition. The authors report the case of a 54-year-old woman with history of anorexia nervosa and chronic alcoholism admitted with acute alcoholic hepatitis. On admission her body mass index (BMI) was 14,5 kg/m², and she started nutrition based on hospital culinary diet with enteric supplementation, adding up to a total intake of 2520 to 2720 kilocalories (Kcal) per day. On day 5 at the ward, the patient developed neurologic symptoms and signs consistent with Wernicke encephalopathy. Soon she developed shock with hypotension, and respiratory failureleading to inotropic support and mechanic ventilation. While in the intensive care unit, blood tests revealed severe hypophosphatemia, hypomagnesaemia, hypokalemia and thiamine deficiency. Other causes of shock, such as infection, pulmonary thromboembolism, acute coronary syndrome or structural heart disease, were excluded. Parenteral phosphate, thiamine, magnesium and potassium were administered and feeding was restarted at a slower rate. Her electrolytes normalized and she gradually improved and was discharged after 30 days with a caloric intake of 1000–1200 Kcal, motivated to maintain a progressive weight increase. This case illustrates the vulnerability of malnourished patientsto refeeding syndrome. Although it is necessary to combat malnutrition, the process of refeeding should be cautious. Measures should be taken to identify the risk of refeeding syndrome and prevent this potentially fatal condition.