Abstract:An extremely low birth weight (ELBW) infant with severe intrauterine growth restriction (IUGR), born at 29 +1 weeks of gestation, developed severe electrolyte disturbances with metabolic acidosis three days after initiation of total parenteral nutrition (TPN). Correction of acidosis and electrolyte imbalance was only achieved after addition of thiamine infusion. This case-report highlights the importance of thiamine therapy in correcting the metabolic acidosis and electrolyte imbalance associated with refeeding syndrome in infants with severe IUGR.