Hypophosphataemia as an element of 'refeeding syndrome' - a complication of nutritional treatment in an extremely neglected 5-year-old girl with infantile cerebral palsy Hipofosfatemia jako jeden z elementów zespo³u refeeding - powik³anie leczenia ¿ywieniowego u skrajnie zaniedbanej 5-letniej dziewczynki z mózgowym pora¿eniem dzieciêcym

Extreme malnutrition in children, similarly as among adults, most often occurs during the course of chronic diseases, but it can also occur in cases of neglect. A 5-year-old girl was admitted due to symptoms of cachexia. Physical examination revealed the following abnormalities: features of cerebral tetraplegia, significant body mass deficiency (8 kg, 44.4%), atrophic subcutaneous and muscular tissue, and pale, dry mucosa of the oral cavity. Laboratory tests showed extreme anaemia in two consecutive assays (Hb 1.7 g/dl). Transfusion of erythrocyte concentrate was urgently performed. Considering the observed aversion to food, highly caloric and high-protein diet and partial parenteral nutrition with complete vitamin and microelement requirements were applied. Laboratory tests during 2-5 days showed decreased levels of phosphorus and calcium characteristic for 'refeeding syndrome', which indicated a long period of starvation. She was nourished only orally for 6 days. The girl gained weight. Gradually red blood cell parameters became normal. We present this case to point out the possibility of complications concerning phosphorus-calcium balance during nutritional treatment in a small child.