title: Thiamin and folic acid deficiency accompanied by resistant electrolyte imbalance in the re-feeding syndrome in an elderly patient.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Istanbul Umraniye Training and Research Hospital, Turkey.
authors.forename: Sibel Ocak
authors.initials: SO
authors.lastname: Serin
authors.affiliation: Department of Anaesthesiology and Reanimation, Istanbul Umraniye Training and Research Hospital, Turkey. Email: drgyilmaz@yahoo.com; dr_mathilda@hotmail.com.
authors.forename: Gulsah
authors.initials: G
authors.lastname: Karaoren
authors.affiliation: Department of Internal Medicine, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey.
authors.forename: Yildiz
authors.initials: Y
authors.lastname: Okuturlar
authors.affiliation: Department of General Surgery, Istanbul Umraniye Training and Research Hospital, Turkey.
authors.forename: Ethem
authors.initials: E
authors.lastname: Unal
authors.affiliation: Department of Internal Medicine, Istanbul Umraniye Training and Research Hospital, Turkey.
authors.forename: Seda
authors.initials: S
authors.lastname: Ahci
authors.affiliation: Department of Internal Medicine, Istanbul Umraniye Training and Research Hospital, Turkey.
authors.forename: Eda
authors.initials: E
authors.lastname: Karakoc
authors.affiliation: Department of Internal Medicine, Istanbul Umraniye Training and Research Hospital, Turkey.
authors.forename: Sema Ucak
authors.initials: SU
authors.lastname: Basat
mesh_terms: D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications; D004573:Electrolytes / Q000008:administration & dosage; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D005494:Folic Acid Deficiency / Q000150:complications* / Q000628:therapy; D006801:Humans; D007362:Intensive Care Units; D044342:Malnutrition / Q000150:complications / Q000628:therapy*; D010288:Parenteral Nutrition / Q000009:adverse effects; D011015:Pneumonia, Aspiration / Q000150:complications / Q000628:therapy*; D055677:Refeeding Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D013832:Thiamine Deficiency / Q000150:complications* / Q000188:drug therapy; D014883:Water-Electrolyte Imbalance / Q000150:complications* / Q000628:therapy
chemical_list: D004573:Electrolytes