Starvation-induced Liver Enzyme Elevation after Initiation of Feeding

Abstract

Exacerbation of liver enzymes after the initiation of feeding in malnourished patients is caused by refeeding syndrome or persistent starvation. There are no definite clinical markers for distinguishing between the two conditions. We herein report a 63-year-old woman with starvation-induced liver enzyme elevation. Her body weight was inversely associated with the liver enzyme levels after refeeding, which was a different course from refeeding syndrome. Normalization of liver enzymes ensued as the caloric intake increased and weight gain progressed. Daily changes in body weight can be a useful clinical marker for distinguishing between refeeding syndrome and starvation-induced liver enzyme elevation.

Keywords: body weight; liver enzyme; refeeding syndrome; resting energy expenditure; starvation.

Figure 1.

The clinical course of the patient. ALT: alanine aminotransferase, AST: aspartate aminotransferase

Figure 2.

Liver histology. (a) Hematoxylin and Eosin staining of the liver revealed ballooning of the hepatocytes and increased brown pigment. (b) Berlin blue and Periodic acid-Schiff staining showed increased hemosiderin (arrows) and lipofuscin in the hepatocytes (arrowheads) (low-power field, ×100).