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Metabolic deterioration in a patient with refractory status epilepticus complicated by refeeding syndrome: a case report
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Manju Mathew
 , Karthiraj Natarajan
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Received December 5, 2025 Accepted March 16, 2026 Published online April 23, 2026
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DOI: https://doi.org/10.15747/ACNM.25.0042
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 Abstract
- A 50-year-old underweight woman with hypothyroidism presented with acute-onset headache, neck pain, vomiting, and transient confusion. She developed seizures in the emergency department requiring intubation. She was subsequently reintubated for refractory status epilepticus, requiring propofol infusion to achieve burst suppression. During her initial intensive care unit course, she had hypoalbuminemia and persistent hypokalemia. Following the initiation of enteral feeding and propofol infusion, she developed metabolic abnormalities suggestive of refeeding syndrome, including severe hypophosphatemia, feed intolerance, and glucose intolerance. A detailed dietary history suggested chronic malnutrition, possibly related to anorexia nervosa. She also exhibited features consistent with propofol infusion syndrome, including hypothermia, elevated lactate, and hemodynamic instability. The interplay between propofol use and refeeding syndrome appeared to trigger a cascade of complications, including worsening hypotension, hyperlactatemia, rhabdomyolysis, hepatic and renal failure, and ultimately fatal cardiac arrest. Refractory status epilepticus requiring propofol infusion, in the context of carbohydrate deprivation and critical illness, may have contributed to catastrophic metabolic deterioration. This case highlights the complexity of metabolic disturbances in critically ill patients and underscores the importance of considering multiple overlapping mechanisms when evaluating clinical deterioration in this setting.
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