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Severe refeeding syndrome after human chorionic gonadotropin diet: a potentially lethal complication
  1. Max J Schunemann1,
  2. Martina Bertschinger2,
  3. Christian Trachsel3 and
  4. Esther Bachli4
  1. 1Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
  2. 2Department of Oncology and Haematology, Kantonsspital Winterthur, Winterthur, Switzerland
  3. 3Department of Medicine, Hospital Uster, Uster, Switzerland
  4. 4Inflammation Research Unit, Department for Internal Medicine, University Hospital Zurich, Schlieren, Switzerland
  1. Correspondence to Dr Max J Schunemann; max.schuenemann{at}


We present the case of a young male patient who presented with paralysing muscle weakness due to severe hypokalaemia and hypophosphataemia. The initial patient history evaluations could not establish the aetiology. Only after we reviewed the patient’s history did he reveal that he had been following a severe calorie-restricted regime, the human chorionic gonadotropin diet, which had ended 2 days prior to developing symptoms. This information then allowed us to diagnose severe refeeding syndrome. As a further complication, the patient developed rhabdomyolysis. After correction of serum electrolytes, symptoms resolved completely. This case emphasises the potential harm of severely calorie-restricted diets, often recommended by online ‘experts’. Furthermore, we underline the importance of thorough history taking.

  • nutrition and metabolism
  • metabolic disorders
  • diet
  • fluid electrolyte and acid-base disturbances

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  • Contributors MJS drafted the manuscript, implemented all changes and inputs and was involved in the patient’s care. MB was involved in the first draft of the manuscript, gave critical input during the revision process, was involved in the patient’s care and was responsible for collecting background information from the patient and his relatives. CT was involved in the patient’s care and gave critical input during the revision process. EB was involved in the patient’s care, gave critical input for the final version of the manuscript and made a substantial contribution to the discussion of the case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.