Acute respiratory failure due to refeeding syndrome and hypophosphatemia induced by hypocaloric enteral nutrition.
We report a case of acute respiratory failure due to refeeding syndrome caused by hypocaloric enteral tube feeds. A 60-y-old obese man, with a diagnosis of esophageal carcinoma with local metastases, underwent feeding jejunostomy tube insertion. Enteral tube feeding was initiated at small volumes providing 4.4 kcal x kg(-1) x d(-1) and gradually increased over 48 h to 29 kcal x kg(-1) x d(-1) (based on adjusted body weight). The patient then developed acute respiratory distress requiring intubation and ventilatory support. Serum phosphorus (P) level was extremely low at <0.7 mg/dL. Serum potassium (K) and magnesium (Mg) levels were also low. It took >4 d to adequately correct the electrolyte derangements. Successful liberation from mechanical ventilation was then possible. In chronically malnourished patients undergoing nutritional support, even hypocaloric feeding should be considered a risk factor for developing refeeding syndrome leading to severe and acute electrolyte fluid-balance and metabolic abnormalities.
Patel
Utpal
U
Department of Anesthesiology, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA.
Sriram
Krishnan
K
D002149:Energy Intake / Q000502:physiology*; D004750:Enteral Nutrition / Q000009:adverse effects*; D006801:Humans; D017674:Hypophosphatemia / Q000150:complications* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D009765:Obesity / Q000150:complications / Q000628:therapy; D055677:Refeeding Syndrome / Q000150:complications* / Q000209:etiology; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012307:Risk Factors; D013997:Time Factors; D014882:Water-Electrolyte Balance / Q000502:physiology