Thiamin and folic acid deficiency accompanied by resistant electrolyte imbalance in re-feeding syndrome in an elderly patient

• Published in: Asia Pacific Journal of Clinical Nutrition Vol. 26; no. 2; pp. 379 - 382
• Main Authors: Serin, Sibel Ocak, Karaoren, Gulsah, Okuturlar, Yildiz, Unal, Ethem, Ahci, Seda, Karakoc, Eda, Basat, Sema Ucak
• Format: Journal Article
• Language: English
• Published: Australia HEC Press 01-01-2017
• Subjects: Aged, 80 and over; Alzheimer Disease - complications; Electrolytes - administration & dosage; Enteral Nutrition - adverse effects; Female; Folic acid deficiency; Folic Acid Deficiency - complications; Folic Acid Deficiency - therapy; Humans; Intensive Care Units; Malnutrition; Malnutrition - complications; Malnutrition - therapy; Parenteral feeding; Parenteral Nutrition - adverse effects; Pneumonia, Aspiration - complications; Pneumonia, Aspiration - therapy; Refeeding Syndrome - diagnosis; Refeeding Syndrome - etiology; Refeeding Syndrome - therapy; Thiamine Deficiency - complications; Thiamine Deficiency - drug therapy; Treatment; Vitamin B1 deficiency; Water-Electrolyte Imbalance - complications; Water-Electrolyte Imbalance - therapy; Water-electrolyte imbalances; Australia; malnutrition; electrolyte imbalance; folic acid; thiamin; re-feeding syndrome
• ISSN: 0964-7058; 1440-6047
• DOI: 10.6133/apjcn.012016.04

Introduction: Re-feeding Syndrome (RS) is a deadly complication, which can be encountered during "refeeding" of malnourished patients. In these patients, thiamin deficiency may develop and "risk awareness" is the most significant factor in the management of these patients. In this case report, the treatment is presented of an elderly patient who was diagnosed with RS and followed-up in the intensive care unit (ICU) due to resistant fluidelectrolyte imbalance.
Case: An 87-year-old elderly woman was admitted to the hospital due to aspiration pneumonia. On day 4, during parenteral nutrition (30 kcal/kg/day), severe electrolyte imbalance developed. Total parenteral nutrition (TPN) was stopped, and enteral feeding together with potassium (90 mmol/day, i.v.) were started. During follow-up, plasma potassium values remained less than 3 mmol/L. Despite replacement therapy, hypoalbuminemia, hypomagnesemia, hypocalcemia, and hypophosphatemia persisted. Considering the parenteral nutrition (30 kcal/kg/day) during the hospitalization period, a diagnosis of RS was made. On day 10, thiamin (200 mg/day, i.v.) and folic acid (5 mg/day) were added, and the patient subsequently responded to electrolyte replacement treatment. The patient was discharged on day26 with a home-care plan.
Conclusion: In patients with malnutrition, thiamin replacement should be given before starting nutrition to prevent RS. Energy intake should be 10kcal/kg/day at the start, and be gradually increased between days 4-10. Hemodynamic-laboratory parameters should be closely monitored. All these measures may be life-saving for patients at high risk.