Hyperglycemia and subsequent torsades de pointes with marked QT prolongation during refeeding

Abstract Objective A fatal cardiac complication can occasionally present in malnourished patients during refeeding; this is known as refeeding syndrome . However, to our knowledge, hyperglycemia preceding torsades de pointes with QT prolongation during refeeding has not been reported. In the present...

Full description

Saved in:
Bibliographic Details
Published in:Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2017-01, Vol.33, p.145-148
Main Authors: Nakashima, Takashi, M.D, Kubota, Tomoki, M.D., Ph.D, Takasugi, Nobuhiro, M.D., Ph.D, Kitagawa, Yuichiro, M.D, Yoshida, Takahiro, M.D, Ushikoshi, Hiroaki, M.D., Ph.D, Kawasaki, Masanori, M.D., Ph.D, Nishigaki, Kazuhiko, M.D., Ph.D, Ogura, Shinji, M.D., Ph.D, Minatoguchi, Shinya, M.D., Ph.D
Format: Article
Language:English
Subjects:
Adult
Anorexia nervosa
Anorexia Nervosa - physiopathology
Anorexia Nervosa - psychology
Arrhythmias, Cardiac - etiology
Arrhythmias, Cardiac - prevention & control
Body Mass Index
Cardiac arrhythmia
Combined Modality Therapy - adverse effects
Diagnostic and Statistical Manual of Mental Disorders
Dietary Supplements
Dopamine
Electrocardiography
Electrolytes
Enteral Nutrition
Female
Gastroenterology and Hepatology
Glucose
Glucose Solution, Hypertonic - administration & dosage
Glucose Solution, Hypertonic - adverse effects
Glucose Solution, Hypertonic - therapeutic use
Humans
Hyperglycemia
Hyperglycemia - etiology
Hyperglycemia - prevention & control
Hypoglycemia
Hypoglycemia - blood
Hypoglycemia - etiology
Hypoglycemia - physiopathology
Hypoglycemia - therapy
Infusions, Intravenous
Japan
Malnutrition
Malnutrition - etiology
Malnutrition - physiopathology
Malnutrition - psychology
Malnutrition - therapy
Metabolism
Patients
QT prolongation
Refeeding syndrome
Refeeding Syndrome - physiopathology
Refeeding Syndrome - prevention & control
Severity of Illness Index
Torsades de pointes
Torsades de Pointes - etiology
Torsades de Pointes - prevention & control
Treatment Outcome
Vitamin B
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Objective A fatal cardiac complication can occasionally present in malnourished patients during refeeding; this is known as refeeding syndrome . However, to our knowledge, hyperglycemia preceding torsades de pointes with QT prolongation during refeeding has not been reported. In the present study, we present a case in which hyperglycemia preceded torsades de pointes with QT prolongation during refeeding. The aim of this study was to determine the possible mechanism underlying QT prolongation during refeeding and indicate how to prevent it. Methods A 32-y-old severely malnourished woman (body mass index 14.57 kg/m2 ) was admitted to the intensive care unit of our institution after resuscitation from cardiopulmonary arrest due to ventricular fibrillation. She was diagnosed with anorexia nervosa. Although no obvious electrolyte abnormalities were observed, her blood glucose level was 11 mg/dL. A 12-lead electrocardiogram at admission showed sinus rhythm with normal QT interval (QTc 0.448). Results Forty mL of 50% glucose (containing 20 g of glucose) was intravenously injected, followed by a drip infusion of glucose to maintain blood glucose level within normal range. After 9 h, the patient's blood glucose level increased to 569 mg/dL. However, after 38 h, an episode of marked QT prolongation (QTc 0.931) followed by torsades de pointes developed. Conclusions Hyperglycemia during refeeding can present with QT prolongation; consequently, monitoring blood glucose levels may be useful in avoiding hyperglycemia, which can result in QT prolongation. Furthermore, additional monitoring of QT intervals using a 12-lead electrocardiogram should allow the early detection of QT prolongation when glucose solution is administered to a malnourished patient with (severe) hypoglycemia.
ISSN:0899-9007
1873-1244
DOI:10.1016/j.nut.2016.05.012