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Patients with Barrett esophagus have poor understanding of the diagnosis and its implications.

failure. The mechanisms of this phenomenon are not fully understood, but insulin could also play a role through its ability to exert an antinatriuretic effect on the renal tubule. Finally, due to the enhanced glucose metabolism, the requirements of certain nutrients, such as thiamine, increase. The essential rule for RS prevention in malnourished patients is to reinitiate nutritional support cautiously. It has been recommended to provide on the first day approximately 25% of estimated needs, increasing them progressively during the next 3 to 5 days. Hypophosphatemia, hypokalemia, and/or hypomagnesemia should be corrected before refeeding. Furthermore, because of the risk of fluid overload, fluid and sodium should be minimized during the first days of nutritional support.1–3 No randomized controlled trials of treatment for RS have been performed, and recommendations are based on reports of small number of patients. If the patient exhibits any signs or symptoms that suggest RS, nutrition should be interrupted immediately. Treatment of electrolyte disturbances should be based on a careful monitoring of their plasma levels. In the case of the phosphate, its optimal dosage and route of administration remains to be determined. In summary, we report a case of a treatable, potentially lethal complication of nutritional support in Crohn’s disease with associated malnutrition. We suggest that phosphate and other intracellular electrolyte concentrations should be routinely monitorized in malnourished Crohn patients before and during nutritional support.