Refeeding Syndrome In Schizophrenia Case Report

Refeeding Syndrome in Schizophrenia

Abstract

Background

Recent studies have shown growing concern for refeeding syndrome (RFS) among patients suffering from other medical conditions, although the exact incidence in this population is unknown. RFS occurs with the rapid reintroduction of calories to severely malnourished patients. It becomes critical for clinicians to have a high incidence of suspicion for prompt diagnosis and appropriate management to keep them alive if the malnutrition does not take their lives.

Case presentation

We report a case of a 53-year-old man with an 8-year history of schizophrenia and a 3-month history of poor feeding. He was admitted on account of refusal to feed or drink for two weeks prior to presentation. As a result, he was severely malnourished, and we started refeeding while dealing with his psychotic symptoms. He gained about 2kg within a week of admission, but that was fraught with metabolic derangements, which included, but were not limited to, hypophosphatemia, hypomagnesaemia, and hypocalcaemia. We revised his diagnosis to RFS in schizophrenia and managed it as such.

Conclusion

Diagnosis of RFS is based on a constellation of electrolyte deficiencies and clinical presentation as there are no agreed biomarkers. Unfortunately, one of the cardinal electrolyte deficiencies, hypophosphatemia, does not have readily available formulations for its correction, and this can lead to neurological, cardiovascular, and other complications, including sudden death. Delay in diagnosis worsens the prognosis, and the intuitive desire to feed a starved patient zealously leads them to death.