A Case of Hemodynamically Unstable Sick Sinus Syndrome Secondary to Refeeding Syndrome

Abstract

Prolonged malnourished states can predispose patients to refeeding syndrome with the uncommon complication of cardiogenic shock if not corrected initially. While refeeding syndrome is well studied its complications may not be easily identified in the setting of rapid deterioration. This case report reviews the events of a 57-year-old male who was brought in by law enforcement, for altered mental status and agitation, after being found wandering in the woods. The patient was initially hemodynamically stable but developed cardiogenic shock from sick sinus syndrome. The patient's shock was non-responsive to IV fluid resuscitation and required ICU admission. Congestive heart failure, ischemic cardiomyopathy, substance abuse, myocarditis, and endocarditis were considered but ruled out. Patient's symptoms improved after electrolyte repletion following brief ICU admission with dopamine drip.

Keywords: cardiac arrhythmia; cardiogenic shock; refeeding syndrome; sick sinus syndrome; tachy-brady syndrome.

Figure 1. Tachycardia with sinus arrest

Figure 2. Persistent sinus bradycardia