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Refractory hypoglycemia and subsequent cardiogenic shock in starvation and refeeding: report of three cases.
[esophageal carcinoma]
Although
starvation
is
associated
with
high
in
-hospital
mortality
,
its
related
cardiac
complications
are
not
sufficiently
understood
.
The
aim
of
this
study
was
to
determine
the
clinical
course
and
pathogenesis
of
cardiac
complications
in
malnourished
patients
.
We
reviewed
three
cases
of
hypoglycemia
and
hypotriglyceridemia
with
cardiac
complications
in
starvation
.
This
report
concerns
three
patients
,
respectively
suffering
from
anorexia
nervosa
,
esophageal
carcinoma
,
and
Parkinson
's
disease
.
Their
ages
ranged
from
18
to
70
y
,
body
mass
index
was
11
.
5
±
1
.
5
kg
/
m
2
(
mean
±
SD
)
,
and
the
main
symptom
was
coma
.
The
average
blood
glucose
level
was
15
.
7
±
7
.
8
mg
/
dL
without
any
history
of
insulin
use
or
diabetes
mellitus
.
In
all
cases
,
hypoglycemia
was
refractory
and
repetitive
so
that
continuous
glucose
administration
was
required
to
maintain
euglycemia
.
Serum
triglyceride
and
non-esterified
fatty
acid
levels
were
also
very
low
(
7
±
4
mg
/
dL
and
10
±
9
.
1
μEq
/
L
,
respectively
)
.
Levels
of
serum
potassium
,
phosphate
,
and
magnesium
were
almost
normal
at
admission
.
The
main
cardiac
complications
included
Takotsubo
cardiomyopathy
and
cardiac
arrest
.
All
patients
survived
as
a
result
of
intensive
treatment
.
Repetitive
severe
hypoglycemia
without
known
background
causes
should
be
viewed
as
an
important
sign
.
Once
this
occurs
,
the
administration
of
a
much
higher
caloric
input
than
usual
accompanied
by
intensive
monitoring
will
be
required
to
maintain
appropriate
glucose
levels
.
The
early
identification
of
such
patients
seems
to
be
essential
to
reduce
the
high
risk
for
cardiac
complications
during
starvation
and
refeeding
.
Diseases
Validation
Diseases presenting
"anorexia"
symptom
alexander disease
allergic bronchopulmonary aspergillosis
aromatase deficiency
carcinoma of the gallbladder
classical phenylketonuria
erdheim-chester disease
esophageal carcinoma
esophageal squamous cell carcinoma
familial hypocalciuric hypercalcemia
hydrocephalus with stenosis of the aqueduct of sylvius
neonatal adrenoleukodystrophy
systemic capillary leak syndrome
triple a syndrome
This symptom has already been validated