Refeeding Syndrome in a Woman with Colorectal Cancer: A Case Report

Abstract

In digestive surgery, nutritional management of an undernourished patient is nowadays systematic and well codified, and must be part of the initial management measures. However, it is not always risk-free, as inadequately managed renutrition of a patient during a period of undernutrition, or during the post-operative period, can have deleterious clinic-biological manifestations, all too often ignored by practitioners, which we group together under the name of refeeding syndrome. Refeeding syndrome reflecting the transition from catabolic to anabolic metabolism usually occurs within five days of refeeding in patients who have undergone prolonged fasting or in a postoperative context including digestive cancer surgery. Patients may present with water-electrolyte disorders, in particular hypophosphatemia and/or hypokalemia and/or hypomagnesemia, thiamine deficiency, as well as neurological, pulmonary, cardiac, neuromuscular and hematological complications, which can lead to the patient's death. Here we present the case of a patient who underwent surgery in the General Surgery Department at Mohamed 6 University Hospital in Tangier for colorectal cancer. The patient subsequently developed an inappropriate refeeding syndrome accompanied by shock and altered consciousness in the postoperative period. Unfortunately, the patient passed away within a few hours following these complications. This is a cause of mortality that can occur without any surgical complications but remains underdiagnosed in daily practice. The management of this syndrome involves first of all the identification of patients at risk and the prevention of it by careful clinic-biological monitoring, including special hydro electrolyte monitoring, as well as the development of feeding reintroduction protocols tailored to each patient's needs.