Case report of refeeding syndrome in a child

R.Yu. Sobko, I.P. Shchurovska, Ya.Ye. Boyko

Abstract


Current problem in patients of the intensive care units is progressive loss of body weight during severe illnesses. After a period of starvation and weight loss, feeding initiation might lead to refeeding syndrome. This state involves abnormalities in fluid balance, glucose metabolism, vitamin deficiency, hypophosphatemia, hypomagnesemia, and hypokalemia. The purpose of this work was to prove the importance of screening patients with suspected high level of refeeding syndrome and to describe a clinical case of fatal course of disease in a child with refeeding syndrome. 15-year-old female patient was admitted to the department of anesthesiology and intensive care of the Western Ukrainian Specialized Children’s Medical Centre with history of rapid weight loss during the last 6 months, general weakness, rapid fatigability, loss of the ability to move independently. Medical history: during last 7 months, the girl deliberately lowered her body weight. Hospital course: the level of consciousness was 8–9 points according to the Glasgow Coma Scale, the patient had hypothermia 35 °C, bradypnea 8–10 per minute, bradycardia 46–52 per minute, arterial hypotension 80/40 mmHg, hypoperfusion of distal parts of the limbs (no pulsation on the arteries) and no peristalsis of the intestines. Urine secretion was maintained at a rate of more than 0.5 ml/kg/h, SpO2 was 95 %. Body weight was 23 kg (with proper weight for age, height and gender — 59 kg), body weight deficiency — 61 %, body mass index — 8.4 kg/m2. On the Malnutrition Universal Screening Tool, the patient was assessed at 6 points, and it was identified that she had a high risk of developing refee­ding syndrome. The prognosis of the disease course was determined as unfavorable because body weight deficiency exceeded 50 %. Combined nutritional support was initiated in a minimal volume: trophic enteral feeding at a rate of 10 ml/kg/day and partial parenteral nutrition at a dose of 10 kcal/kg/day, the volume of infusion was limited to 600 ml/day. On the second day of treatment, severe hypophosphatemia up to 0.4 mmol/l was detected. The patient had developed symptomatic pulmonary edema on the third day after presentation and was unresponsive requiring mechanical ventilation and administration of adrenomimetics. However, the current state of the patient was life-threatening, intensive therapy was ineffective, and the gril died on the third day of hospitalization. Refeeding syndrome is a life-threatening condition for patients, who experienced prolonged starvation. Routine screening for risk factors of malnutrition will help to ve­rify individuals with a significant risk of refeeding syndrome and to take this into account during intensive care.

Keywords


refeeding syndrome; cachexia; nutrition

References


Бутрова С.А. Метаболічний синдром: патогенез, клініка, діагностика, підходи до лікування // РМЖ. — 2001. — Т. 9, № 2.

O’Connor G., Nicholls D. Refeeding Hypophosphatemia in Adolescents With Anorexia Nervosa: A Systematic Review // Nutr. Clin. Pract. — 2013. — 28(3). — 358-64. doi: 10.1177/0884533613476892.

Palesty J.A., Dudrick S.J. Cachexia, malnutrition, the refeeding syndrome, and lessons from Goldilocks // Surg. Clin. North Am. — 2011 Jun. — 91(3). — 653-73. doi: 10.1016/j.suc.2011.02.007.

Skipper A. Refeeding syndrome or refeeding hypophosphatemia: a systematic review of cases // Nutr. Clin. Pract. — 2012 Feb. — 27(1). — 34-40.

Viana L. de A., Burgos M.G., Silva R. de A. Refeeding syndrome: clinical and nutritional relevance // Arq. Bras. Cir. Dig. — 2012 Mar. — 25(1). — 56-9.

Malnutrition Universal Screening Tool (MUST) Malnutrition Advisory Group, UK, May 2004.

National Institute for Health and Clinical Excellence. Nutritional support in adults, Oral nutrition support, enteral tube feeding and parenteral nutrition. Clinical guideline CG32, February 2006.

WHO. Guideline: Updates on the management of severe acute malnutrition in infants and children. — Geneva: World Health Organization, 2013. — http://www.who.int/nutrition/publications/guidelines/updates_management_SAM_infantandchildren/en/.

Manary M., Trehan I., Weisz A. Systematic rewiev of transition phase of children with severe acute malnutrition as inpatients. — 2012. — 8 p. — http://www.who.int/nutrition/publications/guidelines/updates_management_SAM_infantandchildren_review5.pdf




DOI: https://doi.org/10.22141/2224-0586.3.90.2018.129496

Refbacks

  • There are currently no refbacks.


Copyright (c) 2018 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2018

 

 Яндекс.МетрикаSeo анализ сайта Рейтинг@Mail.ru