Hypophosphatemia in malnourished children during nutritional recovery
(refeeding hypophosphatemia) is recognized as a cause of morbidity and
mortality in adolescents with anorexia nervosa but has been only rare
ly reported to occur in younger children with other diagnoses. Over a
6-year period, we encountered three cases of refeeding hypophosphatemi
a in malnourished children admitted to a pediatric rehabilitation hosp
ital, Two children had neurologic dysphagia and one had been starved b
y an abusive parent. The one patient who was symptomatic had obtundati
on, hemolytic anemia, rhabdomyolysis, and hepatocellular injury that b
egan during refeeding and resolved with treatment. The signs and sympt
oms, pathophysiology, and treatment of refeeding hypophosphatemia are
reviewed.