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Role of Thiamine in Refeeding Syndrome in Children

Purpose, Setting and Subjects: We conducted a case report study of a postoperative pediatric patient on total parenteral nutrition managed by a multidisciplinary team in a tertiary care hospital. In October 2020, data of nutritional status, hypophosphatemia, electrolyte and metabolic imbalance, and the role of thiamine supplement were reviewed. Background: Refeeding Syndrome is usually defined as the possibly lethal maldistribution of fluids and electrolytes that could take place in malnourished patients receiving enteral or parenteral refeeding. This is due to hormonal and metabolic disturbances that may lead to critical clinical deterioration. The biochemical key feature of Refeeding Syndrome is hypophosphatemia. In general, the syndrome is complicated and may also incorporate abnormal electrolytes and fluid balance; changes in serum level of protein, glucose, and the metabolism of fat; thiamine deficiency; hypokalemia; and hypomagnesaemia. Case Report: an ex-preterm 6-year-old boy who underwent major intestinal resection due to necrotizing enterocolitis (NEC) during his stormy neonatal period, presented to ED with constipation for 2 days; the patient was admitted in the pediatric ward under combined care with Pediatric Surgery, as a case of large bowel obstruction for conservative management. He had cachexic appearance, global developmental delay (GDD), and faltering growth. Subsequently and during his PICU stay, he suffered a fluctuating course of electrolytes imbalance a few days after commencing total parenteral nutrition (TPN), and developed altered mental status that responded well to thiamine infusions to resume his baseline sensorium within 48 hours. Conclusions: The role of thiamine in Refeeding Syndrome is extremely underestimated, despite the current evidence of its high efficacy. However, the fussy exclusion mechanism to reach the diagnosis is probably the reason behind the delaying of treatment in most of the cases. A wide range of patients are at risk of developing Refeeding Syndrome, especially malnourished children, as in this case report. Categories: Nutrition, Surgery, Pediatrics, Gastroenterology.