Abstract

MARTINEZ-ITURRIAGA, S; TIRAPU-NICOLAS, B  and  BERMEJO-BRAVO, A. Refeeding syndrome in a patient with acute Crohn's disease after primary failure to infliximab. Rev. OFIL·ILAPHAR [online]. 2022, vol.32, n.2, pp.211-213.  Epub Feb 13, 2023. ISSN 1699-714X.  https://dx.doi.org/10.4321/s1699-714x2022000200017.

Refeeding syndrome (RS) is defined as the set of metabolic alterations that occur during nutritional repletion, in patients who are severely malnourished. It manifests with hypophosphatemia, hypokalaemia and hypomagnesemia, abnormalities in fluid balance, alterations in carbohydrate metabolism, and vitamin deficiencies, eg, thiamine. Clinically, it produces neurological, respiratory, cardiovascular and hematological alterations a few days after the start of refeeding, which leads to an increase in patient morbidity and mortality.

There are predisposing factors to the appearance of SR: weight loss of more than 10% of the weight in the previous 4 weeks and chronic diseases such as inflammatory bowel disease (Crohn's disease or ulcerative colitis).

We present the case of a patient with Crohn's disease under treatment with Infliximab who came to the hospital due to pain and digestive symptoms, accompanied by poor nutritional status in which nutritional support was controlled during admission. After 12 days, he presented symptoms of RS that required admission to the ICU. After the nutritional intervention and after hydroelectrolyte replacement, biological therapy was re-evaluated and a decision was made to change the therapeutic target to ustekinumab. After more than a month of admission to the Hospital (in charge of Internal Medicine, Endocrinology, ICU and home hospitalization) the patient reestablishes the nutritional status and refers to an improvement in digestive symptoms. It is essential to prevent RS in this pathology with a high risk of malnutrition, maintaining caloric restriction and hydroelectrolyte replacement.

Keywords : Refeeding syndrome; Crohn's disease.

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