Mr. Ibrahem/Refeeding syndrome
Starvation from one month in a Viet Cong prison camp in 1966.
Specialty	Gastroenterology
Symptoms	Weakness, decreased breathing, poor coordination, confusion, seizures, heart arrythmias [1]
Risk factors	Eating disorders, alcoholism, post surgery, chronic malnutrition, bariatric surgery, inflammatory bowel disease [1]
Diagnostic method	Based on history and blood tests after ruling out other possible causes [1]
Treatment	Gradual reintroduction of calories, vitamin and mineral supplements [1]
Frequency	Unclear [1]

Refeeding syndrome is a condition that may occur following reintroduction of nutrition after a prolonged period of starvation. ^[1] It may also occur with nutrition in the form of total parenteral nutrition. ^[1] It may result in low phosphate, low magnesium, low potassium, and low thiamine. ^[1] This may result in weakness, decreased breathing, poor coordination, confusion, seizures, and heart arrythmias. ^[1]

Risk factors include eating disorders, alcoholism, following surgery, chronic malnutrition, bariatric surgery, and inflammatory bowel disease. ^[1] The underlying mechanism involves increased blood sugar leading to increased insulin levels which results in uptake of potassium and phosphate by cells. ^[1] Diagnosis is based on a decrease in blood levels of phosphate, potassium, or magnesium. ^[1] Mild disease is a decrease of 10 to 20%, moderate disease a decrease of 20 to 30%, and severe disease a decrease of greater than 30%. ^[1]

Treatment is by the gradual reintroduction of calories. ^[1] In the first 24 hours, 10 to 20 kcal/kg or no more than half the person energy requirement, is recommended. ^{[2] [1]} Thiamine supplements should be given early. ^[1] Potassium, phosphate, calcium, and magnesium supplements are also often recommended. ^[2] Electrolytes should be measured every 12 hours initially. ^[1]

Refeeding syndrome's frequency is unclear. ^[1] One study found rates of 0.5% to 18% among people who had been hospitalized. ^[1] Modern descriptions of the condition date from World War II. ^[1] Though, a number of prior descriptions of people dying following eating after a famine occur throughout history. ^{[3] [4]}