Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-10T16:55:53.229Z Has data issue: false hasContentIssue false
  • English
  • Français

The refeeding syndrome; easily overlooked as a cause of delirium in psychiatric and medical intensive care

Published online by Cambridge University Press:  19 July 2012

Imre Krabbenbos ,
Peter Siegers  and
Peter Bruins
Imre Krabbenbos*
Affiliation:
Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital Nieuwegein, The Netherlands
Peter Siegers
Affiliation:
Department of Neurology, St. Antonius Hospital Nieuwegein, The Netherlands
Peter Bruins
Affiliation:
Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital Nieuwegein, The Netherlands
*
Correspondence to: Dr I.P. Krabbenbos, Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital Nieuwegein, Koekoekslaan 1, 3435 CM Nieuwegein. E-mail: i.krabbenbos@antoniusziekenhuis.nl
Get access

Abstract

Background

Delirium is a severe and complex neuropsychiatric disorder and because of its diverse aetiology is often poorly managed. The refeeding syndrome is a well known cause of delirium, characterized by metabolic disturbances elicited during reintroduction of nutrition after a period of starvation. Although a common complication, it is often not recognized by clinicians.

Case

A 53-year-old man presented at the emergency department with psychomotor agitation, irritability and disorientation in time. Apart from previous alcohol abuse he had no documented medical history. Examination led to detection of an intracranial haemorrhage, which could explain cognitive dysfunction. After admission, his level of consciousness gradually improved and he resumed eating and drinking. However, a deterioration of his mental status occurred after three days.

Blood analysis revealed a severe hypophosphataemia indicating refeeding syndrome. After a new dietary regimen and aggressive supplementation of electrolytes his mental state improved rapidly. Following correction of phosphate plasma concentration, no further episodes of severe confusion or disorientation were observed.

Conclusions

This case report illustrates that clinicians in both psychiatric and general intensive care must be aware of the numerous causes of delirium that can be present concurrently. Refeeding syndrome may be overlooked initially when more alarming causes of a delirium are noticed.

Keywords

Hypophosphataemiarefeeding syndromedeliriumcerebrovascular incident
Type
Case Report
Information
Journal of Psychiatric Intensive Care , Volume 9 , Issue 2 , August 2013 , pp. 119 - 123
Copyright
Copyright © NAPICU 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Washington, DC: American Psychiatric Association.Google Scholar
Brunelli, S.M., Goldfarb, S. (2007) Hypophosphatemia: clinical consequences and management. Journal of the American Society of Nephrology. 18: 1999–2003.CrossRefGoogle ScholarPubMed
Caplan, J.P. (2008) Too much too soon? Refeeding syndrome as an iatrogenic cause of delirium. Psychosomatics. 49: 249–251.CrossRefGoogle ScholarPubMed
Dix, R. (2007) Psychiatric Intensive Care – what's in a name? Journal of Psychiatric Intensive Care. 3(1): 1–2.CrossRefGoogle Scholar
Ely, E.W., Gautam, S., Margolin, R., Francis, J., May, L., Speroff, T., Truman, B., Dittus, R., Bernard, R., Inouye, S.K. (2001) The impact of delirium in the intensive care unit on hospital length of stay. Journal of Intensive Care Medicine. 27: 1892–1900.Google Scholar
Ely, E.W., Stephens, R.K., Jackson, J.C., Thomason, J.W., Truman, B., Gordon, S., Dittus, R.S., Bernard, G.R. (2004) Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals. Critical Care Medicine. 32: 106–112.Google Scholar
Ferro, J.M., Caeiro, L., Verdelho, A. (2002) Delirium in acute stroke. Current Opinion in Neurolology. 15: 51–55.Google Scholar
Gaasbeek, A., Meinders, A.E. (2005) Hypophosphatemia: an update on its etiology and treatment. American Journal of Medicine. 118: 1094–1101.Google Scholar
Girard, T.D., Pandharipande, P.P., Ely, E.W. (2008) Delirium in the intensive care unit. Critical Care Medicine. 12 (suppl. 3): S3.Google Scholar
Haring, H.P. (2002) Cognitive impairment after stroke. Current Opinion in Neurology. 15(1): 79–84.CrossRefGoogle ScholarPubMed
Jacobi, J., Fraser, G.L., Coursin, D.B.et al. (2002) Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Critical Care Medicine. 30: 119–141.Google Scholar
Knochel, J.P. (1980) Hypophosphatemia in the alcoholic. Archives of Internal Medicine. 140: 613–615.Google Scholar
Knochel, J.P., Barcenas, C., Cotton, J.R., Fuller, T.J., Haller, R., Carter, N.W. (1978) Hypophosphatemia and rhabdomyolysis. Journal of Clinical Investigation. 62: 1240–1246.Google Scholar
Marik, P.E., Bedigian, M.K. (1996) Refeeding hypophosphatemia in critically ill patients in an intensive care unit: a prospective study. Archives of Surgery. 131: 1043–1047.Google Scholar
McManus, J., Pathansali, R., Stewart, R., Macdonald, A., Jackson, S. (2007) Delirium post-stroke. Age and Ageing. 36: 613–618.CrossRefGoogle ScholarPubMed
Pandharipande, P., Cotton, B.A., Shintani, A., Thompson, J., Pun, B.T., Morris, J.A. Jr, Dittus, R., Ely, E.W. (2008) Prevalence and risk factors for development of delirium in surgical and trauma ICU patients. Journal of Trauma and Acute Care Surgery. 65: 34–41.CrossRefGoogle Scholar
Singhal, P.C., Kumar, A., Desroches, L., Gibbons, N., Mattana, J. (1992) Prevalence and predictors of rhabdomyolysis in patients with hypophosphatemia. American Journal of Medicine. 92: 458–464.CrossRefGoogle ScholarPubMed