Síndrome de realimentação no desnutrido grave: os desafios nutricionais

Abstract

INTRODUCTION: Refeeding Syndrome (RS) is a set of signs and symptoms that occur in a situation of abrupt nutrient supply in malnourished or starving children and adults. Its incidence in pediatrics is unknown and is underreported due to underdiagnosis or insufficient monitoring. Hypophosphatemia is the most characteristic analytical finding of SR, although it is not always present. Hydro-electrolyte disturbances such as hypokalemia and hypomagnesemia can produce cardiac, muscular, and neurological changes with a risk of serious complications. OBJECTIVE: To warn of the severity of this syndrome and to identify patients at risk. CASE REPORT: A 3-year and 5-month-old patient with chronic nonprogressive encephalopathy (CPE), BMI: 10.9 (Z-score -4.76) sought emergency care due to irresponsiveness and pallor. He was hypotheremic, hypoglycemic, and had isochoric and punctiform pupils. After initial management, the patient evolved with eye movement and limb mobility. Laboratory tests were ordered with mild anemia, hospital admission was requested, and a polymeric diet was started via gastrostomy 180ml every 3/3 hours. The patient evolved with hypokalemia, hypomagnesemia, and severe hypophosphatemia. A diagnosis of SR was made and thiamine replacement, correction of hydroelectrolytic disturbances and reduction of the diet was initiated with slow progression. CONCLUSION: The main tool to avoid SR is to perform an adequate prevention. To do this, one should initially identify patients at risk, perform a biochemical evaluation, and progress the diet carefully and slowly. Vitamin supplementation is necessary, especially thiamine.