International ward roundsRefeeding syndrome: A potentially fatal condition but remains underdiagnosed and undertreated
Introduction
Refeeding syndrome is a well-recognized but underdiagnosed and potentially fatal condition that occurs in patients with starvation due to any cause, including anorexia nervosa, diarrhea and vomiting, alcoholism, and after operations [1], [2]. The syndrome can occur with parenteral and enteral feedings and almost always develops during the early stages of refeeding. I describe two cases of refeeding syndrome that highlight the need for a wider awareness of this condition.
Section snippets
Case 1
A 70-y-old woman presented with a 4-mo history of ill health, shortness of breath, lethargy, and difficulty in swallowing. Four days before admission she became drowsy and more breathless. She also complained of dry eyes and mouth. She was known to be hypertensive on nifedipine and was taking steroids until 2 mo before admission for a connective tissue disorder. She also had lost weight but did not know exactly how much.
On clinical examination she was disorientated with a pulse of 120
Discussion
Refeeding syndrome is a well-recognized but underdiagnosed and potentially fatal condition that occurs in patients with starvation due to any cause, including anorexia nervosa, diarrhea and vomiting, alcoholism, and after operations [1], [2]. Malnourished elderly patients and patients with neurologic dysphagia who are being fed through nasogastric and percutaneous endoscopic gastrostomy tubes may also be at risk. [3].
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