Wernike's Encephalopathy as a Part of Refeeding Syndrome

Cases have been reported about refeeding syndrome after bariatric surgery for obesity, in head and neck cancer patients, in patients with anorexia nervosa, hyperemesis gravidarum, in persons on hunger strike, malnourished alcoholic persons and persons doing religious fasting. Refeeding after prolonged fasting can cause severe morbidity and even mortality, if not done properly. Depletion of intracellular electrolytes, depletion of nutrients and vitamins, decreased BMR, decreased renal functions, decreased insulin, decreased GI functions all contribute to it, once you start refeeding. It takes sometime to regain the original functions by the organs and mismatch between supply and increased demand after refeeding can cause havoc. Here we report the case of a person, who did water only fasting for 51 days and developed refeeding syndrome and Wernike's encephalopathy four days after starting liquid diet.