• Takashi Nakashima, Tomoki Kubota, Nobuhiro Takasugi, Yuichiro Kitagawa, Takahiro Yoshida, Hiroaki Ushikoshi, Masanori Kawasaki, Kazuhiko Nishigaki, Shinji Ogura, and Shinya Minatoguchi.
• Department of Cardiology, Gifu University, Graduate School of Medicine, Gifu, Japan. Electronic address: takashin727jw@yahoo.co.jp.
• Nutrition. 2017 Jan 1; 33: 145-148.

ObjectiveA fatal cardiac complication can occasionally present in malnourished patients during refeeding; this is known as refeeding syndrome. However, to our knowledge, hyperglycemia preceding torsades de pointes with QT prolongation during refeeding has not been reported. In the present study, we present a case in which hyperglycemia preceded torsades de pointes with QT prolongation during refeeding. The aim of this study was to determine the possible mechanism underlying QT prolongation during refeeding and indicate how to prevent it.MethodsA 32-y-old severely malnourished woman (body mass index 14.57 kg/m(2)) was admitted to the intensive care unit of our institution after resuscitation from cardiopulmonary arrest due to ventricular fibrillation. She was diagnosed with anorexia nervosa. Although no obvious electrolyte abnormalities were observed, her blood glucose level was 11 mg/dL. A 12-lead electrocardiogram at admission showed sinus rhythm with normal QT interval (QTc 0.448).ResultsForty mL of 50% glucose (containing 20 g of glucose) was intravenously injected, followed by a drip infusion of glucose to maintain blood glucose level within normal range. After 9 h, the patient's blood glucose level increased to 569 mg/dL. However, after 38 h, an episode of marked QT prolongation (QTc 0.931) followed by torsades de pointes developed.ConclusionsHyperglycemia during refeeding can present with QT prolongation; consequently, monitoring blood glucose levels may be useful in avoiding hyperglycemia, which can result in QT prolongation. Furthermore, additional monitoring of QT intervals using a 12-lead electrocardiogram should allow the early detection of QT prolongation when glucose solution is administered to a malnourished patient with (severe) hypoglycemia.Copyright © 2016 Elsevier Inc. All rights reserved.

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