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Starvation ketoacidosis and refeeding syndrome
  1. Angela Heulwen Boal,
  2. Maurizio Panarelli and
  3. Caroline Millar
  1. Department of Clinical Biochemistry, NHS Greater Glasgow and Clyde, Glasgow, UK
  1. Correspondence to Dr Angela Heulwen Boal; angela.boal{at}


Starvation ketoacidosis (SKA) is a rarer cause of ketoacidosis. Most patients will only have a mild acidosis, but if exacerbated by stress can result in a severe acidosis. We describe a 66-year-old man admitted with reduced consciousness and found to have a severe metabolic acidosis with raised anion gap. His body mass index (BMI) was noted to be within the healthy range at 23 kg/m2; however, it was last documented 1 year previously at 28 kg/m2 with no clear timeframe of weight loss. While his acidosis improved with intravenous fluids, he subsequently developed severe electrolyte imbalance consistent with refeeding during his admission. Awareness of SKA as a cause for high anion gap metabolic acidosis is important and knowledge of management including intravenous fluids, thiamine, dietetic input and electrolyte replacement is vital.

  • malnutrition
  • metabolic disorders
  • nutrition
  • nutritional support

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  • Contributors AHB helped in research and manuscript preparation, MP helped in manuscript preparation and review. CM involved in patient’s care while in hospital, manuscript preparation and review.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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