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Refeeding syndrome and central pontine myelinolysis in the patient with anorexia nervosa

Miroslav Sekot, Vladimir Kmoch, Ondrej Dolezal, Hana Papezova

Am J Case Rep 2009; 10:139-140

ID: 878186

Background: Refeeding syndrome has been defined as the rapid electrolyte and fluid shift in patients with malnutrition undergoing realimentation. This syndrome can occur in alcoholism and eating disorders. Wrong diagnosis could have consequences, such as Wernicke-Korsakoff syndrome or central pontine myelinolysis (CPM). Central pontine myelinolysis is neurologic disorder defi ned by symmetric demyelination of central base of the cerebral stem. This condition originally described in chronic alcohol abusers suffering from malnutrition, could be observed in patients with eating disorders and electrolyte imbalance, where realimentation is needed. Until recently its outcome was considered invariably poor if not fatal (75% mortality).
Case Report: A 21-year-old female patient with two years duration of anorexia nervosa. The patient developed CPM after rapid recovery of hyponatremia, hypokalemia and hypochloremia. Her main symptoms were perimaleolar edema and, serious cognitive defi cit, bradypsychism, progressing bulbar symptoms of
dysarthria, dysphagia and cephalea, walking instability and tetanic spasms. NMR imaging showed hyperintensity in the brain stem, small hyperintensity lession in corpus callosum. The course of this case report was favourable.
Conclusions: We may conclude that the CPM is relatively rare, nevertheless quite serious, and often misdiagnosed condition. It should be considered in patients with mental anorexia, particularly in those presenting with the clinical picture described above.

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