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Refeeding Syndrome in Children in Developing Countries Who Have Celiac Disease

Agarwal, Jaya; Poddar, Ujjal; Yachha, Surender K.; Srivastava, Anshu

Journal of Pediatric Gastroenterology & Nutrition: April 2012 - Volume 54 - Issue 4 - p 521–524
doi: 10.1097/MPG.0b013e318242fe1d
Original Articles: Hepatology and Nutrition

Objectives: The clinical presentations of celiac crisis and refeeding syndrome in celiac disease are almost similar, but information about refeeding syndrome is scarce. We are reporting for the first time 5 cases of refeeding syndrome in children with celiac disease that could have otherwise been labeled as celiac crisis.

Methods: From January to December 2010, a chart review of hospital records of all celiac disease cases was performed, and refeeding syndrome was ascribed in those celiac patients who deteriorated clinically after initiation of a gluten-free diet and had biochemical parameters suggestive of refeeding syndrome such as hypophosphatemia, hypokalemia, hypocalcemia, and hypoalbuminemia.

Results: Of the total 35 celiac disease patients, 5 (median age 6.5 [range 2.2–10] years, 3 boys) were identified as having refeeding syndrome. All 5 children were severely malnourished (body mass index <14 kg/m2) and all of them had anemia, hypophosphatemia, hypokalemia, hypoalbuminemia, and hypocalcemia, meaning that they had the perfect setting for developing refeeding syndrome. At the same time, their clinical features fulfilled the criteria for celiac crisis except that their symptoms have worsened after the introduction of a gluten-free diet. Nevertheless, instead of using steroids, they were managed as refeeding syndrome in terms of correction of electrolytes and gradual feeding, and that led to a successful outcome in all of them.

Conclusions: Severely malnourished patients with celiac disease are at risk of developing potentially life-threatening refeeding syndrome, which may mimic celiac crisis, especially in developing countries. Early recognition and appropriate treatment are the keys to a successful outcome.

Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Address correspondence and reprint requests to Dr Ujjal Poddar, Associate Professor, Department of Pediatric Gastroenterology, SGPGIMS, Lucknow 226014, India (e-mail:

Received 21 June, 2011

Accepted 9 October, 2011

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN