Refeeding syndrome refers to the metabolic complications that occur when starting the refeeding process. Risk factors include very low body weight, severe malnutrition and rapid weight loss.

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Hypokalemia, or low serum potassium, from malnutrition or purging may predispose anorexia nervosa patients to sudden cardiac death. Low potassium has the potential to contribute to QTc prolongation, which may trigger TdP.  Especially in conjunction with elevated serum aldosterone levels which further exacerbate it, hypokalemia has the potential to lead to deadly outcomes. Furthermore, low potassium may also indicate refeeding syndrome, which can lead to death by acute heart failure.

Hypokalemia and Sudden Cardiac Death in Anorexia Nervosa Patients

Chidiac, C. (2019). An update on the medical consequences of anorexia nervosa. Current Opinion in Pediatrics, 31 (4), 448-453. doi: 10.1097/MOP.0000000000000755.

An update on the medical consequences of anorexia nervosa

A patient's QTc interval reflects the time it takes for ventricular depolarization and repolarization to occur, measured from the beginning of the QRS complex to the end of the T wave, corrected for their heart rate. In other words, it represents the time needed for the heart to reset between beats.

QT Corrected for Heart Rate (QTc) Interval

Aldosterone (ALD) is a hormone that regulates sodium and potassium levels, contributing to blood pressure regulation. It increases sodium levels, thereby also increasing blood volume via water retention, and increases the amount of potassium excreted in urine. Among adults, generally 3.1 – 35.4 ng/dL is considered normal.

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