Refeeding Syndrome with Hypoglycemia in a Severely Malnouris
Refeeding syndrome is defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding. It is caused by increased serum insulin level with refeeding followed by an intracellular shift of glucose, potassium, magnesium, and phosphate. Clinical manifestations usually include hypophosphatemia, hypokalemia, hyperglycemia, and thiamine deficiency. Hyperglycemia is a common associated finding and is explained by insufficient insulin supply at initial feeding.

A 5-months-old severely malnourished 3.5 kg boy was brought to the emergency department with hypoglycemia, bradycardia, bradypnea, and hypothermia. His findings were likely due to severe malnutrition secondary to parental neglect. Resuscitation with dextrose containing intravenous fluids was promptly started. On day 2 of admission, refeeding was initiated. From that time, he had multiple hypoglycemic episodes along with hypophosphatemia, hypomagnesemia, and hypokalemia. Hypoglycemia was associated with the initiation of enteral feeding and an increase in calories and amounts of enteral feeding. Hypoglycemia associated with refeeding syndrome in infant has not been previously reported.