Refeeding syndrome: The danger of feeding a starving man

Refeeding syndrome is a potentially fatal clinical condition characterized by severe electrolyte and fluid shifts associated with metabolic abnormalities in severely malnourished or starved patients undergoing oral, enteral or parenteral re-feeding. We here present a case of a 50-year-old Indian male with a background of depression and alcoholic liver disease presented with alleged ingestion of a detergent. He subsequently developed an oesophageal stricture resulting in severe malnutrition. He developed re-feeding syndrome following commence- ment of TPN associated with clear biochemical alteration. This was immediately identified and rectified. This case report highlights the prevalence of refeeding syndrome in a typical hospital setting that can easily be overlooked and stresses the importance of early recognition as this is a preventable disorder. Clin Ter 2014; 165(4):??-??. doi: 10.7417/CT.2014.???? ingestion of a detergent. He allegedly had a similar suicide attempt in 2008, during which he sustained diffuse erosive injury of the oesophagus, stomach and posterior wall of first part of duodenum. The patient thereafter defaulted follow-up. During presentation the patient was clearly under alcohol influence and complained of upper abdominal pain, coffee ground vomiting and diarrhoea. He was admitted for obser- vation and discharged, the next day. Upon discharge, he was able to tolerate normal diet, remained haemodynamically stable with no evidence upper gastrointestinal bleeding. He had normal blood parameters and his symptoms had resolved with tablet esomeprazole 40 mg daily.