Hypophosphataemia as an element of ‘refeeding syndrome’ – a complication of nutritional treatment in an extremely neglected 5-year-old girl with infantile cerebral palsy

Extreme malnutrition in children, similarly as among adults, most often occurs during the course of chronic diseases, but it can also occur in cases of neglect. A 5-year-old girl was admitted due to symptoms of cachexia. Physical examination revealed the following abnormalities: features of cerebral tetraplegia, significant body mass deficiency (8 kg, 44.4%), atrophic subcutaneous and muscular tissue, and pale, dry mucosa of the oral cavity. Laboratory tests showed extreme anaemia in two consecutive assays (Hb 1.7 g/dl). Transfusion of erythrocyte concentrate was urgently performed. Considering the observed aversion to food, highly caloric and high-protein diet and partial parenteral nutrition with complete vitamin and microelement requirements were applied. Laboratory tests during 2-5 days showed decreased levels of phosphorus and calcium characteristic for ‘refeeding syndrome’, which indicated a long period of starvation. She was nourished only orally for 6 days. The girl gained weight. Gradually red blood cell parameters became normal. We present this case to point out the possibility of complications concerning phosphorus-calcium balance during nutritional treatment in a small child.