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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Abstract titles should be brief and reflect the content of the abstract.
Refeeding syndrome (RFS) is a serious complication that occurs as a consequence of feeding after a period of starvation. It is characterized by metabolic and electrolyte imbalance, most notably hypophosphatemia, as well as hypokalemia, hypomagnesemia, and heart failure, which can lead to fatal outcomes. Early recognition and prevention of RFS is therefore of great importance.
Nephrologists, who provide comprehensive management of serum electrolyte levels, urine output, and acid–base balance, are frequently consulted for the management of RFS. Dietitians also play an important role in the management of RFS based on a thorough assessment of nutritional status. We herein report a case of 50-year-old woman with RFS treated with close discussion between nephrologists and dietitians.
[Case presentation] 50-year-old female with 10-year-history of anorexia nervosa was admitted to the emergency department for altered mental status. Her Body Mass Index was 11 kg/m^2. She was found to have severe hypoglycemia, hypophosphatemia, and hypokalemia, which were thought to be at high risk of RFS. Intravenous thiamine supplementation and correction of electrolyte abnormalities were initiated. As a central venous catheter infection developed only three days after admission, intravenous electrolyte correction and parenteral nutrition were switched to oral administration. Potassium chloride tablets and monobasic sodium phosphate monohydrate were administered to improve hypokalemia and hypophosphatemia. Nutritional counseling provided by dietitians was initiated.
Although electrolyte correction with oral medication was successful, nutritional management remained challenging because the patient was reluctant to eat, and peripheral parenteral nutrition alone was insufficient to prevent recurrent hypoglycemia. Therefore, nephrologists requested that dietitians ensure she consumed an additional 200–400 kcal/day orally. Through frequent counseling, dietitians identified that she preferred biscuits, cheese, and yogurt. She was instructed to consume 30 to 60 kcal-biscuits before bedtime to prevent hypoglycemia, while dairy-based meals were switched to cheese, yogurt and jelly. To avoid RFS, oral intake was carefully increased, and by day 30, she was able to consume 1,200 kcal per day orally. Continuous adjustment of meal composition and repeated interactions between the patient and the dietitian helped establish rapport and contributed significantly to maintaining adherence to nutritional therapy.
Patients with RFS are sometimes immuno-compromised and prone to catheter-related infection, making electrolyte correction and energy administration difficult. Establishing oral intake as soon as possible is very important. Nonetheless, patients with a history of anorexia nervosa, malignant tumors, or alcohol addiction which frequently lead to RFS often have difficulties with oral intake. Dietitians are crucial for evaluating the reasons why each patient is unable to consume food orally.
