Abstract
This is a case report of a 43-year-old female who had been repeatedly admitted and discharged from the hospital's psychiatric department since being diagnosed with anorexia nervosa at 30 years of age. She was admitted to a different hospital after slipping into a coma at home. She was diagnosed as having shock and hypoglycemia due to dehydration and malnutrition. Total parenteral nutrition was administered, while ensuring adequate fluid replacement. However, she was subsequently transported to the ICU of our hospital on Day 13 of treatment with evidence of multiple organ failure. She was diagnosed as having the refeeding syndrome, because the parenteral nutrition had been administered without correcting the hypophosphatemia. She was found to have significant hypophosphatemia (IP 0.5 mg/dl), and was administered a low-calorie infusion solution, which resulted in improvementof the serum phosphorus level. The patient recovered from the shock and her organ functions improved, followed by recovery of the serum phosphorous level. The importance of nutritional management has been recognized; however, refeeding syndrome is difficult to recognize in the emergency and intensive care settings. It is therefore important to bear the possibility of refeeding syndrome in mind when providing nutritional management to patients with anorexia nervosa. In addition, it is important to administer nutritional support starting with a low-calorie diet containing microelements to avoid the onset of organ failure.
