This case report highlights a concerning and complex case of a middle-aged female presenting with severe malabsorption, diarrhea, and subsequent malnutrition. The patient's weight dramatically dropped from 85 lbs to 50 lbs over the course of two to four months. The medical history included ongoing pancreatitis, esophageal ulcers, and previous surgeries for a dermoid cyst in the brain and cervical neoplasia. Upon admission to the hospital, the patient received total parenteral nutrition (TPN) on the first day, but this led to delirium due to refeeding syndrome. Refeeding syndrome is a well-known condition that can occur when malnourished individuals receive too much nutrition too quickly, causing metabolic imbalances and potentially serious complications. Subsequently, during the second hospitalization, the patient did not receive TPN but was instead administered 5% dextrose with 20 mEq of potassium chloride (KCl). Unfortunately, her condition worsened, leading to multiorgan failure. During the third hospitalization, TPN was reintroduced under consultation and hospitalist evaluation, and the patient's symptoms improved. Overall, this case report outlines a complex case with multiple medical issues, including severe malnutrition, which required careful management and consideration of the patient's unique needs. It underscores the importance of cautious nutritional support for severely malnourished individuals to avoid complications such as refeeding syndrome. The case also emphasizes the value of interdisciplinary collaboration and continuous monitoring to achieve successful outcomes in such complex situations.
Keywords: abnormal weight loss; acute-on-chronic pancreatitis; anorexia nervosa (an); protein energy malnutrition (pem); total parenteral nutrition (tpn).
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