Case of the Month #43 Refeeding Syndrome

1. Cardiovascular 

Patients are more vulnerable to heart failure and fluid overload due to atrophy of heart and thiamine deficiency during starvation. 

A resting heart rate >70 beats/minute may suggest heart failure. Prolonged starvation tends to develop bradycardia. 

2. Respiratory 

Hypophosphatemia impairs the diaphragmatic contractility. 

3. Gastrointestinal 

Transaminases are mildly elevated due to either fat deposition or cell death- apoptosis. 

Diarrhoea may develop due to atrophy of intestinal mucosa. 

4. Neurology 

Severe electrolyte abnormality may manifest as paresthesia, delirium, tremor and seizures. 

Thiamine deficiency may cause Wernicke encephalopathy associated with oculomotor dysfunction and gait ataxia.