Correspondence
An Additional Symptom
The article (1) refers to a topic that is commonly observed on a global scale. I worked for “Doctors without Borders/Médecins Sans Frontières” in South Sudan for three months and witnessed often how children who were extremely malnourished could not be saved in spite of doctors’ best efforts. Measuring electrolyte concentrations—as suggested in the article—was not possible in our small laboratory. But the clinical symptoms described in the article were something that we observed in every case.
One additional symptom also occurred repeatedly: if the children in spite of extreme weakness started to hyperventilate and blood glucose concentrations were raised, this was an indication that the point of no return had been reached. After careful/cautious intravenous administration of insulin and glucose we then observed how the weakness rapidly subsided, breathing normalized, and the children were not only able to drink but also tolerated food.
One explanation for this phenomenon could be that malnutrition triggers multiorgan failure, which also affects the pancreas. Subsequently, no insulin can be produced and in turn the organ failure further deteriorates, in a vicious cycle. Once insulin has been administered, the cells can absorb nutrients and energy, and the body recovers.
The question is whether raised blood glucose concentrations with hyperventilation also occur in adults and whether they too might be helped with this therapeutic approach.
DOI: 10.3238/arztebl.m2023.0155
Dr. med. Reinhard v. Kietzell
Pediatrician
Lüneburg
rkietzell@t-online.de
Conflict of interest statement
The author declares that no conflict of interest exists.
| 1. | Heuft L, Voigt J, Selig L, Stumvoll M, Schlögl H, Kaiser T: Refeeding syndrome—diagnostic challenges and the potential of clinical decision support systems. Dtsch Arztebl Int 2023; 120: 107–14 VOLLTEXT |
