背景:饥饿酮症酸中毒(SKA)是一般人群中酮症酸中毒的罕见原因,但可以在恶性肿瘤中看到。患者通常对治疗反应良好,但有些人很少发展为再喂养综合征(RFS),因为他们的电解质下降到危险水平,导致器官衰竭。通常,RFS可以用低热量饲料管理,但有时患者需要停止进食,直到他们的电解质失衡得到控制。
方法:我们讨论了一名正在化疗的滑膜肉瘤患者,该患者被诊断为SKA,然后在静脉注射葡萄糖治疗后出现严重的RFS。磷,钾,镁水平急剧下降,并在6天内保持波动。她还出现了正常的窦性室性心动过速,室性早搏,和bigeminy。她当时不能忍受热量补充。她接受电解质紊乱治疗,直到临床稳定,然后进展为流质饮食。
结论:我们提出了一个特殊的严重SKA病例,该病例导致RFS需要6天的NPO治疗。没有针对SKA或RFS管理的具体指南。pH<7.3的患者可能受益于基线血清磷,钾,和镁水平。需要进行临床试验,以进一步研究哪些患者可以从低热量摄入开始与那些需要保持营养直到临床稳定的患者中受益。
结论:完全停止热量摄入,直到患者的电解质失衡得到改善,是RFS强调和研究的重要管理方面,即使使用谨慎的再喂养方案,也可能发生严重的并发症。
BACKGROUND: Starvation ketoacidosis (SKA) is a rare cause of ketoacidosis in the general population but can be seen with malignancy. Patients often respond well to treatment, but some rarely develop refeeding syndrome (RFS) as their electrolytes drop to dangerous levels causing organ failure. Typically, RFS can be managed with low-calorie feeds, but sometimes patients require a halt in feeds until their electrolyte imbalances are managed.
METHODS: We discuss a woman with synovial sarcoma on chemotherapy who was diagnosed with SKA and then developed severe RFS after treatment with intravenous dextrose. Phosphorus, potassium, and magnesium levels dropped precipitously and remained fluctuant for 6 days. She also developed normal sinus ventricular tachycardia, premature ventricular beats, and bigeminy. She could not tolerate calorie supplementation at that time. She was managed with electrolyte repletions until clinically stable and then progressed to a liquid diet.
CONCLUSIONS: We present a unique case of severe SKA that resulted in RFS requiring nihil per orem (
NPO) treatment for 6 days. There are no specific guidelines for SKA or RFS management. Patients with pH < 7.3 may benefit from baseline serum phosphorus, potassium, and magnesium levels. Clinical trials are needed to further study which patients may benefit from starting at a low-calorie intake versus those that require holding nutrition until clinically stable.
CONCLUSIONS: Completely stopping caloric intake until a patient\'s electrolyte imbalance improves is an important management aspect of RFS to underscore and study, as grave complications can occur even with cautious refeeding regimens.