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healthy soch
New Delhi, June 20, 2019:
We know Lychee has been involved in Muzaffarpur children death
· Mostly children
· Mostly malnourished
· Present with convulsions
· High mortality inspite of replacing sugar levels
· Toxins hypoglycin A in lychee and their components in patient’s urine
· Mostly absence of fever
What might be happening
In significantly malnourished children, who have not eaten food for more than three days if they are given oral (lychee in this case), enteral, or parenteral nutritional replenishment can cause electrolyte and fluid shifts that may precipitate disabling or fatal medical complications.
The refeeding syndrome is marked by: Hypophosphatemia, Hypokalemia, Congestive heart failure, Peripheral edema, Rhabdomyolysis, Seizures, fever and Hemolysis. Hypophosphatemia is the hallmark of the syndrome and predominant cause of the refeeding syndrome.
Rapidly treating hypoglycaemia with IV or oral sugar will harm without managing the electrolyte imbalance. The best food in these situations is sugarcane juice and not lychee.
The risk of hypophosphatemia during refeeding appears to be greater in patients who are more severely malnourished and at lower percent of ideal body weight. People may have higher hemoglobin levels due to dehydration and intravascular volume depletion.
The pathogenesis of hypophosphatemia begins when stores of phosphate are depleted during episodes of starvation. When nutritional replenishment starts and patients are fed carbohydrates, glucose causes release of insulin, which triggers cellular uptake of phosphate (and potassium and magnesium) and a decrease in serum phosphorous levels. Insulin also causes cells to produce a variety of depleted molecules that require phosphate (adenosine triphosphate and 2,3-diphosphoglycer1ate), which further depletes the body’s stores of phosphate.
The subsequent lack of phosphorylated intermediates causes tissue hypoxia, myocardial dysfunction, respiratory failure due to an inability of the diaphragm to contract, haemolysis, rhabdomyolysis, and seizures.
Risk factors for the re-feeding syndrome include low baseline levels of phosphate, potassium, or magnesium prior to re-feeding the patient; and little or no nutritional intake for the previous 5 to 10 days. Patients are at the highest risk for the re-feeding syndrome in the first one to two weeks of nutritional replenishment and weight gain.
Generally, the risk progressively dissipates over the next few weeks if there has been consistent forced intake and weight gain.
Suggestion
Treat these patients as re-feeding syndrome and not as simple hypoglycaemia.
Hypophosphatemia or hypokalemia can be treated orally with sodium phosphate or potassium phosphate in two divided doses to correct deficits.
Dr KK Aggarwal
healthysoch
HealthySoch
