Hyperglycaemia in the refeeding syndrome in an anxious and depressed patient - case report

Introduction: Inanition is a state of extreme exhaustion characterized by severe nutritional and electrolyte deficiencies, often resulting from starvation, malnutrition, or intestinal disorders. During starvation, fatty acids derived from lipolysis replace glucose as the primary energy source, with subsequent metabolism into ketone bodies. Refeeding syndrome refers to a cluster of metabolic and clinical abnormalities that arise from the rapid reintroduction of nutrition in malnourished individuals. This report aims to highlight a case of hyperglycemia during refeeding following prolonged inanition in a patient with anxiety and depression. Case Presentation: A 37-year-old female presented to the emergency department with complaints of extreme fatigue, paresthesias in her extremities, abdominal pain, bloating, anorexia, and significant weight loss of approximately 25 kg over six months. Laboratory findings revealed elevated blood glucose and lactate levels, hypokalemia, and urinalysis abnormalities, including glucosuria, ketonuria, leukocyturia, and hematuria. The patient, with a history of anxiety-depressive disorder, reported being homebound for six months due to worsening urinary and fecal incontinence over three years. During this time, she experienced severe nutritional deprivation. In the days leading up to her admission, she had uncontrolled access to large quantities of carbohydrates, which she consumed rapidly. Discussion: The patient’s prolonged period of intermittent food intake followed by abrupt, excessive carbohydrate consumption led to the development of refeeding syndrome. This was characterized by hyperglycemia and hypokalemia, alongside the electrolyte and metabolic imbalances associated with starvation-induced depletion. Notably, this case underscores the occurrence of refeeding syndrome and hyperglycemia outside a controlled hospital setting, emphasizing the potential risks of unsupervised refeeding in malnourished individuals. Conclusion: This case highlights the need for increased awareness of refeeding syndrome, particularly in non-clinical settings. Refeeding should be initiated gradually under close medical supervision to prevent complications. Accurate risk assessment and timely identification of individuals susceptible to refeeding syndrome are crucial for effective management.