Hadid Bana, Arman Farid, Shirazian Shayan
State University of New York Downstate Health Sciences University, College of Medicine, Brooklyn, and.
Columbia University, Department of Nephrology, NY, USA.
Clin Nephrol Case Stud. 2023 Jun 29;11:104-109. doi: 10.5414/CNCS111119. eCollection 2023.
Starvation ketoacidosis (SKA) is a rare cause of ketoacidosis in the general population but can be seen with malignancy. Patients often respond well to treatment, but some rarely develop refeeding syndrome (RFS) as their electrolytes drop to dangerous levels causing organ failure. Typically, RFS can be managed with low-calorie feeds, but sometimes patients require a halt in feeds until their electrolyte imbalances are managed.
We discuss a woman with synovial sarcoma on chemotherapy who was diagnosed with SKA and then developed severe RFS after treatment with intravenous dextrose. Phosphorus, potassium, and magnesium levels dropped precipitously and remained fluctuant for 6 days. She also developed normal sinus ventricular tachycardia, premature ventricular beats, and bigeminy. She could not tolerate calorie supplementation at that time. She was managed with electrolyte repletions until clinically stable and then progressed to a liquid diet.
We present a unique case of severe SKA that resulted in RFS requiring nihil per orem (NPO) treatment for 6 days. There are no specific guidelines for SKA or RFS management. Patients with pH < 7.3 may benefit from baseline serum phosphorus, potassium, and magnesium levels. Clinical trials are needed to further study which patients may benefit from starting at a low-calorie intake versus those that require holding nutrition until clinically stable.
Completely stopping caloric intake until a patient's electrolyte imbalance improves is an important management aspect of RFS to underscore and study, as grave complications can occur even with cautious refeeding regimens.
饥饿性酮症酸中毒（SKA）在普通人群中是酮症酸中毒的罕见病因，但在恶性肿瘤患者中可见。患者通常对治疗反应良好，但有些患者很少会发展为再喂养综合征（RFS），因为他们的电解质降至危险水平，导致器官衰竭。通常，RFS可以通过低热量喂养来管理，但有时患者需要停止喂养，直到他们的电解质失衡得到控制。
我们讨论一名正在接受化疗的滑膜肉瘤女性患者，她被诊断为SKA，在接受静脉葡萄糖治疗后发展为严重的RFS。磷、钾和镁水平急剧下降，并持续波动6天。她还出现了窦性心动过速、室性早搏和二联律。当时她无法耐受热量补充。她通过补充电解质进行管理，直到临床稳定，然后逐渐过渡到流食。
我们报告了一例独特的严重SKA病例，该病例导致RFS，需要禁食6天。目前尚无关于SKA或RFS管理的具体指南。pH<7.3的患者可能会从基线血清磷、钾和镁水平中获益。需要进行临床试验，以进一步研究哪些患者可能从低热量摄入开始获益，哪些患者需要在临床稳定之前停止营养支持。
在患者的电解质失衡改善之前完全停止热量摄入是RFS管理的一个重要方面，需要强调和研究，因为即使采用谨慎的再喂养方案也可能发生严重并发症。
