Abstract
Refeeding syndrome is a potentially life-threatening metabolic complication that occurs with rapid reintroduction of nutrition following prolonged starvation, including in patients with anorexia nervosa. The article presents a clinical case of a 15-year-old girl with severe restrictive anorexia nervosa (BMI 10,7 kg/m2, body weight 27 kg), admitted in a state of extreme cachexia with pronounced hypophosphatemia (0,45 mmol/L), hypokalemia, bradycardia (HR 30 bpm), and a rare complication-spontaneous pneumomediastinum with subcutaneous emphysema of the neck and interstitial pulmonary emphysema. The diagnosis of refeeding syndrome was verified according to the ASPEN 2020 consensus (severe degree). Treatment involved cautious escalation of caloric intake (initially 5–10 kcal/kg/day), parenteral and enteral nutritional support, correction of phosphorus, thiamine, electrolytes, and symptomatic therapy. Positive dynamics were achieved during treatment: weight gain to 40,45 kg (BMI – 16 kg/m2), normalization of electrolyte balance, and regression of pneumomediastinum. The case highlights the need for high vigilance regarding refeeding syndrome in adolescents with anorexia nervosa, mandatory prophylactic administration of thiamine and electrolytes, gradual increase in caloric intake, and daily laboratory monitoring during the first 7–10 days of nutritional rehabilitation.
Keywords: anorexia nervosa, refeeding syndrome, refeeding hypophosphatemia, spontaneous pneumomediastinum, nutritional status, eating disorder.
For citation:Ilenkova N.A., Chikunov V.V., Alekseeva O.V. Refeeding syndrome in pediatric practice: a case report. Clinical review for general practice. 2026; 7 (6): 118–123 (In Russ.). DOI: 10.47407/kr2026.7.6.00873
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