title: Hyperglycemia and subsequent torsades de pointes with marked QT prolongation during refeeding.
abstract: OBJECTIVE
  A fatal cardiac complication can occasionally present in malnourished patients during refeeding; this is known as refeeding syndrome. However, to our knowledge, hyperglycemia preceding torsades de pointes with QT prolongation during refeeding has not been reported. In the present study, we present a case in which hyperglycemia preceded torsades de pointes with QT prolongation during refeeding. The aim of this study was to determine the possible mechanism underlying QT prolongation during refeeding and indicate how to prevent it.
  
  
  METHODS
  A 32-y-old severely malnourished woman (body mass index 14.57 kg/m2) was admitted to the intensive care unit of our institution after resuscitation from cardiopulmonary arrest due to ventricular fibrillation. She was diagnosed with anorexia nervosa. Although no obvious electrolyte abnormalities were observed, her blood glucose level was 11 mg/dL. A 12-lead electrocardiogram at admission showed sinus rhythm with normal QT interval (QTc 0.448).
  
  
  RESULTS
  Forty mL of 50% glucose (containing 20 g of glucose) was intravenously injected, followed by a drip infusion of glucose to maintain blood glucose level within normal range. After 9 h, the patient's blood glucose level increased to 569 mg/dL. However, after 38 h, an episode of marked QT prolongation (QTc 0.931) followed by torsades de pointes developed.
  
  
  CONCLUSIONS
  Hyperglycemia during refeeding can present with QT prolongation; consequently, monitoring blood glucose levels may be useful in avoiding hyperglycemia, which can result in QT prolongation. Furthermore, additional monitoring of QT intervals using a 12-lead electrocardiogram should allow the early detection of QT prolongation when glucose solution is administered to a malnourished patient with (severe) hypoglycemia.
authors.affiliation: Department of Cardiology, Gifu University, Graduate School of Medicine, Gifu, Japan. Electronic address: takashin727jw@yahoo.co.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakashima
authors.affiliation: Department of Cardiology, Gifu University, Graduate School of Medicine, Gifu, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Kubota
authors.affiliation: Department of Cardiology, Gifu University, Graduate School of Medicine, Gifu, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Takasugi
authors.affiliation: Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kitagawa
authors.affiliation: Department of Emergency and Disaster Medicine, Gifu University, Graduate School of Medicine, Gifu, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of Cardiology, Gifu University, Graduate School of Medicine, Gifu, Japan; Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ushikoshi
authors.affiliation: Department of Cardiology, Gifu University, Graduate School of Medicine, Gifu, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Kawasaki
authors.affiliation: Department of Cardiology, Gifu University, Graduate School of Medicine, Gifu, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nishigaki
authors.affiliation: Department of Emergency and Disaster Medicine, Gifu University, Graduate School of Medicine, Gifu, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Ogura
authors.affiliation: Department of Cardiology, Gifu University, Graduate School of Medicine, Gifu, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Minatoguchi
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000503:physiopathology / Q000523:psychology; D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000517:prevention & control; D015992:Body Mass Index; D003131:Combined Modality Therapy / Q000009:adverse effects; D039721:Diagnostic and Statistical Manual of Mental Disorders; D019587:Dietary Supplements; D004750:Enteral Nutrition; D005260:Female; D005950:Glucose Solution, Hypertonic / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology* / Q000517:prevention & control; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007262:Infusions, Intravenous; D007564:Japan; D044342:Malnutrition / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D055677:Refeeding Syndrome / Q000503:physiopathology* / Q000517:prevention & control; D012720:Severity of Illness Index; D016171:Torsades de Pointes / Q000209:etiology* / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D005950:Glucose Solution, Hypertonic
keywords: Anorexia nervosa; Hypoglycemia; QT prolongation; Refeeding syndrome; Torsades de pointes