Refeeding syndrome (RFS) is defined as the potentially fatal shifts in fluid and electrolytes that may occur in malnourished patients who are abruptly refed either enterally or parenterally. The biochemical hallmark is hypophosphatemia. Other changes can include hypokalemia, hypomagnesemia, and thiamin deficiency. RFS can worsen the prognosis of children with celiac crisis as well (JPGN 2012; 54: 522-5).
A chart review from Lucknow, India from Jan-Dec 2010, identified 5 cases of RFS among 35 celiac patients. All were severely malnourished. All had anemia, hypoalbuminemia, hypophosphatemia, hypokalemia, and hypomagnesemia. All improved with initial caloric restriction followed by gradual escalation of caloric intake along with electrolyte supplementation.
This article shows that a variety of causes of malnutrition can lead to refeeding syndrome. Considering refeeding syndrome in any severely malnourished child may help improve the prognosis by altering the nutritional management.
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