Overfeeding: A Rare Cause of Failure to Wean Identified via Indirect Calorimetry

Abstract

Acute overfeeding-related problems are seldom reported in literature when compared to the effects of underfeeding. A 41year female patient, on chronic antipsychotic medications (tab Olanzapine at 20 mg/day), presented do the intensive care unit (ICU) with severe shortness of breath and decreased responsiveness. She had very poor oral intake for the last 3 months. On admission, her height was 160 cm, weight was 50 kg (ideal body weight -55 kg), and body mass index (BMI), 19.5 kg/m 2 . Her serum albumin on admission was 2.0 g/dL with mild anemia ( hemoglobin -8.5 g/dL). The initial estimated caloric requirement was 1600 kcal/ day, proteins -56 g, to reach target at 5 th day. Initial feeding was started at 10 kcal/kg /day with 0.5 g/kg /day of protein with close watch on potassium and phosphorous, as part of the dreaded "refeeding syndrome," and she slowly progressed to goal over five days.