[Refeeding syndrome] in a Kuwaiti child: clinical diagnosis and management

To report a case of refeeding syndrome in a Kuwaiti child, its clinical presentation and management. A 13-month-old Kuwaiti boy presented with acute severe malnutrition in the form of marasmic kwashiorkor. On admission, blood sugar and serum electrolytes were normal but on the 3rd day he developed typical biochemical features of refeeding syndrome in the form of hyperglycemia, severe hypophosphatemia, hy-pokalemia, hypocalcemia and hypomagnesemia. The child then received treatment appropriate for refeeding syndrome in the form of lower calorie intake with gradual increase, as well as supplementation of electrolytes, thiamine and vitamins and he eventually made a safe recovery. This case showed that during rehabilitation of a malnourished child, a severe potentially lethal electrolyte disturbance [refeeding syndrome] can occur. Careful monitoring of electrolytes before and during the refeeding phase was needed and helped to detect this syndrome early. We suggest that slow and gradual calorie increase in the 'at-risk' patient can help prevent its occurrence

Hypoglycemic coma in a young girl: first case of medium chain Acyl-Co Dehydrogenase [MCAD] deficiency identified in Kuwait

Medium-chain acyl CoA dehydrogenase [MCAD] deficiency is the commonest inborn error of fatty acid oxidation. Affected children usually present within the first two years of life with re c u r rent episodes of hypoketotic hypoglycemia and lethargy with high risk of mortality and morbidity. We describe a two-year old girl who presented with hypoglycemic hypoketotic coma due to MCAD and we describe the investigative work-up that led to the diagnosis. Our aim is to increase awareness of this disorder and to emphasize the need for prompt diagnosis and management. This is the first case of MCAD deficiency identified in Kuwait and we believe that this condition may be under-diagnosed