![]() Depletion of phosphorus causes a reduction in ventricular myocyte contractility further propagating cardiogenic shock. Sick sinus syndrome is a well-known complication of refeeding syndrome, predominantly mediated through serum electrolyte abnormalities causing abnormal conduction of cardiac signals . A review of cardiac telemetry readings showed a pattern suggestive of sick sinus syndrome with tachycardia and sinus arrest (Figure (Figure1), 1), followed by progression into persistent bradycardia with a mean heart rate of 40-45 (Figure 2). His blood pressure was gradually declining from an early morning reading of 105/70 to 65/40 by noon his heart rate on cardiac telemetry demonstrated a high degree of variance with a range of 50 to 140 beats per minute.Ī transthoracic echocardiogram was ordered showing ejection fraction 50-54%, no significant diastolic dysfunction or wall motion abnormality, and trivial valvulopathy. On hospital day 2, the patient continued to be delirious, uncooperative, and agitated. Following admission, the patient was allowed to eat an unrestricted diet. The patient had an unknown history of alcohol abuse and was started on IV fluids with supplementation of IV thiamine/multivitamin “Banana Bag” in the emergency department but the infusion was not able to be completed as the patient removed his own IV access. The patient refused intravenous (IV) and per oral (PO) medications including IV fluids.
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