Faculty mentor/PI email address
jim010@aol.com
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Keywords
Refeeding syndrome; hypophosphatemia; persons experiencing homelessness, malnutrition; electrolyte disturbances; emergency medicine
Date of Presentation
5-6-2026 12:00 AM
Poster Abstract
Refeeding syndrome (RFS) is a potentially life-threatening metabolic disturbance that occurs following nutritional reintroduction in severely malnourished individuals. It is characterized by rapid intracellular shifts of electrolytes—most notably hypophosphatemia—driven by insulin-mediated metabolic changes. Although commonly associated with eating disorders and chronic illness, RFS may also occur in socially vulnerable populations.
We report the case of a 64-year-old male experiencing homelessness who presented to the emergency department with weakness, muscle cramps, and confusion after resuming regular meals at a local shelter following prolonged minimal intake. Laboratory evaluation revealed severe hypophosphatemia (0.7 mg/dL), hypokalemia (3.0 mmol/L), and hypomagnesemia (1.2 mg/dL). Electrocardiogram demonstrated sinus tachycardia without ischemic changes.
Management included thiamine supplementation prior to carbohydrate advancement, aggressive electrolyte repletion, telemetry monitoring, and cautious caloric advancement. The patient improved clinically and was discharged with coordinated social and psychiatric follow-up.
This case underscores the importance of early recognition of RFS in high-risk populations, including individuals experiencing homelessness, and highlights the critical role of emergency physicians in initiating timely prevention and management strategies.
Disciplines
Community Health | Digestive System Diseases | Medicine and Health Sciences | Therapeutics
Refeeding Syndrome in a Person Experiencing Homelessness: A Case Report
Refeeding syndrome (RFS) is a potentially life-threatening metabolic disturbance that occurs following nutritional reintroduction in severely malnourished individuals. It is characterized by rapid intracellular shifts of electrolytes—most notably hypophosphatemia—driven by insulin-mediated metabolic changes. Although commonly associated with eating disorders and chronic illness, RFS may also occur in socially vulnerable populations.
We report the case of a 64-year-old male experiencing homelessness who presented to the emergency department with weakness, muscle cramps, and confusion after resuming regular meals at a local shelter following prolonged minimal intake. Laboratory evaluation revealed severe hypophosphatemia (0.7 mg/dL), hypokalemia (3.0 mmol/L), and hypomagnesemia (1.2 mg/dL). Electrocardiogram demonstrated sinus tachycardia without ischemic changes.
Management included thiamine supplementation prior to carbohydrate advancement, aggressive electrolyte repletion, telemetry monitoring, and cautious caloric advancement. The patient improved clinically and was discharged with coordinated social and psychiatric follow-up.
This case underscores the importance of early recognition of RFS in high-risk populations, including individuals experiencing homelessness, and highlights the critical role of emergency physicians in initiating timely prevention and management strategies.