Refeeding syndrome associated with hypoglycemia in patients with severe malnutrition

Abstract

Refeeding syndrome is typically characterized by water and electrolyte imbalance and cardiac complications associated with rapid nutritional supplementation in severely malnourished patients. However, the relationship between refeeding syndrome and hypoglycemia has not been clearly elucidated.

This study reviewed 12 Japanese patients with body mass index (BMI) < 14 who developed refeeding syndrome associated with hypoglycemia, 10 of whom developed fatal cardiac complications such as Takotsubo cardiomyopathy and cardiac arrest. The detailed underlying mechanisms remain largely unclear, although it has been postulated to result from hypoglycemia and consequent excessive catecholamine secretion induced by excessive insulin secretion upon rapid energy supplementation in malnutrition, which in turn causes Takotsubo cardiomyopathy. Insufficient energy supply to the cardiac muscle may also be involved in cardiac complications.

Refeeding syndrome can potentially become critical, so systemic management such as electrocardiography monitoring and management of electrolytes and blood glucose level is necessary in patients with severe malnutrition. Prevention of refeeding syndrome and associated metabolic and cardiac complications is vital. In addition, strict nutritional management with appropriate set targets of energy supplementation based on measurement of energy expenditure is essential to safely improve nutritional status.