title: Refeeding Syndrome: An Important Complication Following Obesity Surgery.
abstract: BACKGROUND
  Refeeding syndrome (RFS) is an important and well-known complication in malnourished patients, but the incidence of RFS after obesity surgery is unknown and the awareness of RFS in obese patients as a postsurgical complication must be raised. We present a case of RFS subsequent to biliopancreatic diversion in a morbidly obese patient.
  
  
  METHODS
  A 48-year-old female patient with a BMI of 41.5 kg/m2 was transferred to our hospital due to Wernicke's Encephalopathy in a global malabsorptive syndrome after biliopancreatic diversion. Parenteral nutrition, vitamin supplementation and high-dosed intravenous thiamine supplementation were initiated. After 14 days, the patient started to develop acute respiratory failure, and neurological functions were impaired. Blood values showed significant electrolyte disturbances. RFS was diagnosed and managed according to the NICE guidelines. After 14 days, phosphate levels had returned to normal range, and neurological symptoms were improved.
  
  
  CONCLUSIONS
  Extreme weight loss following obesity surgery has been shown to be associated with undernutrition. These patients are at high risk for evolving RFS, even though they may still be obese. Awareness of RFS as a postsurgical complication, the identification of patients at risk as well as prevention and correct management should be routinely performed at every bariatric center.
authors.affiliation: Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Chiappetta
authors.forename: Jürgen
authors.initials: J
authors.lastname: Stein
mesh_terms: D015904:Biliopancreatic Diversion / Q000009:adverse effects*; D015992:Body Mass Index; D019587:Dietary Supplements / Q000009:adverse effects; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000601:surgery; D020915:Korsakoff Syndrome / Q000209:etiology*; D008286:Malabsorption Syndromes / Q000178:diet therapy / Q000209:etiology; D044342:Malnutrition / Q000178:diet therapy / Q000209:etiology; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D055677:Refeeding Syndrome / Q000209:etiology*; D013270:Stomach / Q000601:surgery; D015431:Weight Loss / Q000502:physiology*