Nutritional management of celiac crisis in an elderly adult: A case report of the rare presentation of celiac disease in a 75-y-old woman

In adults, a very uncommon presentation of celiac disease (CD) is a celiac crisis, a life-threatening and severe form of the disease having a dramatic onset with diarrhea and metabolic acidosis with electrolyte and fluid imbalance. Treatment of celiac crisis requires a gluten-free diet; however, the...

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Bibliographic Details
Published in:Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2020-11, Vol.79-80, p.110858, Article 110858
Main Authors: Cava, Edda, Collo, Alessandro, Capello, Elena Cecilia, Mazza, Fabrizio, Riso, Sergio
Format: Article
Language:English
Subjects:
Acidosis
Activities of daily living
Adults
Age
Aged
Antibodies
Asthenia
Autoimmune diseases
Biopsy
Body weight loss
Case reports
Celiac crisis
Celiac disease
Celiac Disease - complications
Celiac Disease - therapy
Complications
Crises
Diarrhea
Diarrhea - etiology
Diarrhea - therapy
Diet
Diet, Gluten-Free
Disease
Edema
Electrolytes
Endoscopy
Enzymes
Family medical history
Female
Food
Food intolerance
Gastrointestinal symptoms
Gluten
Humans
Intestine
Malabsorption
Malnutrition
Meals
Metabolic acidosis
Metabolism
Nutrition
Older people
Parenteral nutrition
Patients
Proteins
Recovery
Refeeding syndrome
Sarcopenia
Serology
Steatorrhea
Vomiting
Water-Electrolyte Imbalance
Weight loss
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Summary:In adults, a very uncommon presentation of celiac disease (CD) is a celiac crisis, a life-threatening and severe form of the disease having a dramatic onset with diarrhea and metabolic acidosis with electrolyte and fluid imbalance. Treatment of celiac crisis requires a gluten-free diet; however, the risk for refeeding syndrome (RFS) should be considered in patients showing marked malabsorption symptoms and important unintentional weight loss. Therefore, to avoid metabolic and potentially fatal complications of re-nutrition, nutritional management is crucial for a safe recovery after a celiac crisis. This review reports the rare onset of celiac crisis in a 75-y-old woman presenting with severe malnutrition resulting in >40% weight loss in 3 mo, after a period of severe diarrhea and vomiting. She arrived at the hospital showing electrolyte imbalance, hypoalbuminemia, lower limb edema, multiple bowel movements (>10/d) with steatorrhea, sarcopenia with profound asthenia, hyporexia due to intolerance to any food, and vomiting after meals. After being diagnosed with CD, the first approach was a gluten-free diet, which demonstrated only small and slow improvements of gastrointestinal symptoms. Therefore, a second approach was parenteral nutrition (PN) support that dramatically helped the patient's recovery. Here we describe the nutritional management during the inpatient stay for clinical stabilization and the following outpatient visits during and after the support with PN, until the patient's complete recovery to a regular follow-up. •New-onset celiac disease (CD) in adults >65 y of age is becoming more common, often with atypical presentation.•Celiac crisis is a rare manifestation of CD and confers a high risk for refeeding syndrome, a life‐threatening condition requiring careful nutritional support.•Nutritional support is crucial to prevent refeeding syndrome, allowing a quick recovery in patients rarely resistant to a gluten-free diet.•We report the nutritional management in a gluten-free diet-resistant patient at risk for refeeding syndrome, requiring parenteral nutrition to recover from a celiac crisis.
ISSN:0899-9007
1873-1244
DOI:10.1016/j.nut.2020.110858