Refeeding syndrome in schizophrenia from an emerging economy

Abstract Background Recent studies have shown growing concern for refeeding syndrome (RFS) among patients suffering other medical conditions although the exact incidence in this population is unknown. The phenomenon is also present among patients with mental health conditions characterized by poor feeding, poor appetite, catatonic features and poor cognitive functioning. Generally, RFS occurs with the reintroduction of calories to severely malnourished patients which doing so may be intuitive but life-threatening. 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 did 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. He was severely malnourished and feeding was started 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 not limited to, hypophosphatemia, hypomagnesaemia and hypocalcaemia. We revised his diagnosis to RFS in schizophrenia and managed as such. Conclusion There are no agreed biomarkers for the diagnosis of Refeeding Syndrome and diagnosis is still based on a constellation of electrolyte deficiencies and clinical presentation. 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 zealously feed a starved patient rather leads them to their death.