Table 01: Changes in serum electrolytes during this admission TIMELINE Baseline Refeeding Syndrome Recovery Na (mmol/L) 133 141 140 142 153 K (mmol/L) 2.4 1.8 2.3 2.5 3.5 Mg (mg/dL) 1.5 1.2 PO (mg/dL) 4.1 2.7 1.6 1.9 2.3 3.2 Ca (mg/dL) 9.2 8.04 8.3 8.34 8.3 8.8 EACS2023: 1192 Navigating the shadows: refeeding syndrome in late-stage HIV diagnosis – a case report N. Gunarathna , B. Samarasinghe , S. De Alwis , H.T. Liyanage , P.A.D.M.P. Perera , G. Samaraweera , H. Karunathilake National STD/AIDS Control Programme, Colombo, Sri Lanka, National Hospital of Sri Lanka, Colombo, Sri Lanka Title Clinical case title: Navigating the shadows: refeeding syndrome in late-stage HIV diagnosis – a case report Clinical case body Text: Refeeding syndrome is a potentially fatal condition leading to significant low-serum electrolyte levels, severe circulatory fluid overload, and organ failure in severely malnourished individuals undergoing hastened and imbalanced refeeding. Hypophosphatemia is defined as the the most distinctive clinical feature of this syndrome along with hypokalemia, and hypomagnesemia. Refeeding syndrome among people living with HIV frequently remains under-recognised or inappropriately treated. Herein, we present the first diagnosed case of refeeding syndrome in a 35-year-old man with AIDS in Sri Lanka. He presented with chronic diarrhoea of 18 months duration (Bristol stool score 7) with a frequency of 5-6 times a day. His BMI had dropped from 21.8 Kg/m2 to 14.3 Kg/m2 during this illness and was severely malnourished (GLIM criterion stage 2). Further investigations revealed positive HIV status with a CD4 count of 130 cells/µL and was diagnosed with HIV wasting syndrome. Stool full report, microscopy, and culture were normal. Opportunistic infections screening, hepatitis B and C were negative. The upper and lower gastrointestinal endoscopies were unremarkable. He was initiated on co-trimoxazole prophylaxis with the HIV diagnosis. With the enteral refeeding, he developed hypophosphatemia, hypomagnesemia, and worsening hypokalemia. Therefore, a diagnosis of refeeding syndrome was made. He was promptly managed with daily IV thiamine and KCl, Joulie's solution, MgSO4, CaCO3, Vitamin D3, and multivitamins. His symptoms did not worsen nor did he develop any organ failures. Gradually, he was introduced to a normal routine diet. Subsequently, antiretroviral treatment was started with tenofovir disoproxil fumarate, emtricitabine, and efavirenz. In individuals at late stages of HIV presenting with chronic gastrointestinal symptoms, refeeding syndrome may not be considered as the reason for electrolyte imbalances, fluid overload, and organ failure. Therefore, a high degree of suspicion and awareness about this uncommon syndrome is necessary among HIV clinicians. General conditions 1. I confirm that I previewed this clinical case and that all information is correct. I accept that the content of this clinical case cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of this clinical case constitutes the consent to publication (e.g. conference website, programmes, other promotions, etc.).: Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the clinical case. The corresponding author is responsible for informing the other authors about the status of the clinical case.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with theprivacy policy to provide the services described.: Yes 1 2 2 1 1 1 2 1 2 + + 2+ 32+ 908 19TH EUROPEAN AIDS CONFERENCE | WARSAW 2023
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