A Case of Successful Neurological Critical Care for the Very-High-Risk Refeeding Syndrome With Central Nervous System Disorders

Refeeding syndrome potentially causes death from refeeding-induced central nervous system disorders, such as hypoglycemic encephalopathy, Wernicke encephalopathy, and hypophosphatemic encephalopathy. However, there is no established management for malnourished patients with this refeeding-induced central nervous system syndrome. We report a case of successful neurological critical care for refeeding-induced central nervous system syndrome. A 15-year-old female with anorexia nervosa presented to our hospital after fainting. Her body mass index (BMI) was 8.8 kg/m². Upon arrival, her Glasgow Coma Scale was E4V4M6, plasma glucose was 25 mg/dL, aspartate aminotransferase was 1393 U/L, and alanine transaminase was 1368 U/L. We started a continuous 5% dextrose. However, her Glasgow Coma Scale dropped to E4V1M1 1 hour later, and her plasma glucose was 28 mg/dL. We delivered her to the neurological critical care unit and started critical nutritional management. Her laboratory data had gradually improved. On day five from admission, her Glasgow Coma Scale had improved to G4V4M6. On day 15. She was transferred to the psychiatric department. In conclusion, clinicians should recognize that refeeding-induced central nervous system syndrome is neurologically critical and life-threatening. However, our management successfully improved this patient's condition. Additionally, she gained enough weight on day 15 after admission. Our moderate-calorie nutritional management might be adequate for refeeding-induced central nervous system syndrome. However, it is a little too exaggerated to conclude that our management is safe and the best nutritional management, based only on this case. We recommend a future observational study as the next step.