Severe refeeding hypophosphatemia in a CAPD patient: a case report

Area of Science:

• Nephrology
• Internal Medicine
• Clinical Nutrition

Background:

• Refeeding syndrome involves electrolyte and fluid shifts in malnourished patients.
• Hypophosphatemia is a primary concern, but typically rare in uremic patients due to hyperphosphatemia.

Observation:

• A 56-year-old continuous ambulatory peritoneal dialysis (CAPD) patient developed ileus and diarrhea, requiring total parenteral nutrition (TPN).
• Despite initial high serum phosphate and adjusted TPN, severe hypophosphatemia (0.3 mg/dL) rapidly developed.
• The patient experienced loss of consciousness and cardiac arrest despite phosphate supplementation.

Findings:

• Severe refeeding hypophosphatemia can occur early in patients with hyperphosphatemia.
• This case demonstrates a critical deviation from the typical presentation of refeeding syndrome in uremic patients.
• Prompt recognition and management of electrolyte imbalances are crucial in TPN-dependent patients.

Implications:

• Clinicians must consider refeeding hypophosphatemia even in hyperphosphatemic, uremic patients on TPN.
• Careful titration of phosphate during nutritional resuscitation is essential.
• This case underscores the potential for rapid and severe metabolic derangements in dialysis patients receiving TPN.