Hypophosphatemia in malnourished children during refeeding.

Hypophosphatemia in malnourished children during nutritional recovery (refeeding hypophosphatemia) is recognized as a cause of morbidity and mortality in adolescents with anorexia nervosa but has been only rarely reported to occur in younger children with other diagnoses. Over a 6-year period, we encountered three cases of refeeding hypophosphatemia in malnourished children admitted to a pediatric rehabilitation hospital. Two children had neurologic dysphagia and one had been starved by an abusive parent. The one patient who was symptomatic had obtundation, hemolytic anemia, rhabdomyolysis, and hepatocellular injury that began during refeeding and resolved with treatment. The signs and symptoms, pathophysiology, and treatment of refeeding hypophosphatemia are reviewed.