Refeeding Syndrome in a Malnourished Patient
🩺 Case Study: Refeeding Syndrome in a Malnourished Patient
Date: August 7, 2025
Tags: Refeeding Syndrome, Electrolyte Imbalance, Clinical Case, Internal Medicine
🧑⚕️ Patient Profile
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Age/Sex: 42-year-old male
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History: Chronic alcohol use disorder, poor oral intake for 10–12 days
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Presenting Complaint: Generalized weakness, shortness of breath, and mild confusion two days after re-initiation of feeding
📋 Background
The patient was admitted to the medical ward with signs of dehydration, weight loss, and fatigue. His BMI was 16.2, and he appeared cachectic. After stabilization with IV fluids, enteral nutrition via NG tube was started at 1,200 kcal/day without electrolyte correction or thiamine supplementation.
⚠️ Clinical Deterioration
48 hours after feeding:
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The patient became disoriented and developed muscle cramps
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Tachycardia (HR: 110 bpm), tachypnea (RR: 24/min)
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ECG showed flattened T waves and U waves
🧪 Laboratory Findings
| Test | Result | Normal Range |
|---|---|---|
| Serum phosphate | 0.5 mg/dL | 2.5–4.5 mg/dL |
| Serum potassium | 2.7 mEq/L | 3.5–5.0 mEq/L |
| Serum magnesium | 1.2 mg/dL | 1.5–2.5 mg/dL |
| Serum glucose | 130 mg/dL | — |
| ABG | Mild metabolic alkalosis | — |
✅ Diagnosis: Refeeding Syndrome
A potentially fatal shift in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding, particularly with carbohydrate-rich feeds. Hallmarked by hypophosphatemia, often accompanied by hypokalemia, hypomagnesemia, and vitamin deficiencies.
🩹 Management
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Feeds held immediately
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IV phosphate, potassium, and magnesium replacement
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Started on thiamine 100 mg IV daily
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Gradual reintroduction of feeds over 5–7 days
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Strict monitoring of electrolytes every 12 hours
🧠 Learning Points
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Always assess refeeding risk: low BMI, significant weight loss, prolonged fasting
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Start low and go slow: 10 kcal/kg/day initially in high-risk patients
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Supplement thiamine and multivitamins before initiating feeds
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Monitor phosphate, potassium, magnesium, and glucose
📌 Take-Home Message
Refeeding syndrome is preventable but potentially fatal. In malnourished patients, the reintroduction of nutrition must be done cautiously and with appropriate monitoring to avoid serious complications.
📍 Posted by Dr. Jabir Khan – for educational awareness among students and professionals.
🖋️ Feel free to share this case with credit!
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