{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:40:19Z","timestamp":1756374019562,"version":"3.44.0"},"reference-count":20,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,10,17]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:p>We present the case of a young male patient who presented with paralysing muscle weakness due to severe hypokalaemia and hypophosphataemia. The initial patient history evaluations could not establish the aetiology. Only after we reviewed the patient\u2019s history did he reveal that he had been following a severe calorie-restricted regime, the human chorionic gonadotropin diet, which had ended 2\u2009days prior to developing symptoms. This information then allowed us to diagnose severe refeeding syndrome. As a further complication, the patient developed rhabdomyolysis. After correction of serum electrolytes, symptoms resolved completely. This case emphasises the potential harm of severely calorie-restricted diets, often recommended by online \u2018experts\u2019. Furthermore, we underline the importance of thorough history taking.<\/jats:p>","DOI":"10.1136\/bcr-2021-244011","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T11:33:09Z","timestamp":1637148789000},"page":"e244011","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Severe refeeding syndrome after human chorionic gonadotropin diet: a potentially lethal complication"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8008-7411","authenticated-orcid":false,"given":"Max J","family":"Schunemann","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University Hospital Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Bertschinger","sequence":"additional","affiliation":[{"name":"Department of Oncology and Haematology, Kantonsspital Winterthur, Winterthur, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Trachsel","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hospital Uster, Uster, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther","family":"Bachli","sequence":"additional","affiliation":[{"name":"Inflammation Research Unit, Department for Internal Medicine, University Hospital Zurich, Schlieren, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,11,17]]},"reference":[{"key":"2025082802005981000_14.11.e244011.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a301"},{"key":"2025082802005981000_14.11.e244011.2","doi-asserted-by":"crossref","DOI":"10.7326\/0003-4819-35-1-69","article-title":"A clinical study of malnutrition in Japanese prisoners of war","volume":"35","author":"Schnitker","year":"1951","journal-title":"Ann Intern Med"},{"key":"2025082802005981000_14.11.e244011.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0899-9007(01)00542-1"},{"key":"2025082802005981000_14.11.e244011.4","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1016\/S0140-6736(54)92556-8","article-title":"The action of chorionic gonadotrophin in the obese","volume":"267","author":"Simeons","year":"1954","journal-title":"Lancet"},{"key":"2025082802005981000_14.11.e244011.5","unstructured":"Food and Drug Administration . Avoid dangerous hCG diet products, 2020. Available: https:\/\/www.fda.gov\/consumers\/consumer-updates\/avoid-dangerous-hcg-diet-products [Accessed April 2021]."},{"key":"2025082802005981000_14.11.e244011.6","doi-asserted-by":"crossref","first-page":"55","DOI":"10.2174\/157488609787354369","article-title":"Drug-Induced hypokalaemia","volume":"4","author":"Ben Salem","year":"2009","journal-title":"Curr Drug Saf"},{"key":"2025082802005981000_14.11.e244011.7","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/MNH.0000000000000329","article-title":"Iron-Induced hypophosphatemia: an emerging complication","volume":"26","author":"Zoller","year":"2017","journal-title":"Curr Opin Nephrol Hypertens"},{"key":"2025082802005981000_14.11.e244011.8","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1002\/ncp.10474","article-title":"Aspen consensus recommendations for refeeding syndrome","volume":"35","author":"da Silva","year":"2020","journal-title":"Nutr Clin Pract"},{"key":"2025082802005981000_14.11.e244011.9","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.nut.2008.09.010","article-title":"Refeeding syndrome still needs to be recognized and managed appropriately","volume":"25","author":"Panteli","year":"2009","journal-title":"Nutrition"},{"key":"2025082802005981000_14.11.e244011.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.nut.2009.11.017"},{"key":"2025082802005981000_14.11.e244011.11","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ejcn.1602854"},{"key":"2025082802005981000_14.11.e244011.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.nut.2014.03.026"},{"key":"2025082802005981000_14.11.e244011.13","first-page":"26","article-title":"Much ado about refeeding","volume":"29","author":"McCray","year":"2005","journal-title":"Practical Gastroenterology"},{"key":"2025082802005981000_14.11.e244011.14","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.nut.2016.12.017","article-title":"Cardiogenic shock caused by a left midventricular obstruction during refeeding in a patient with anorexia nervosa","volume":"35","author":"Sakamoto","year":"2017","journal-title":"Nutrition"},{"key":"2025082802005981000_14.11.e244011.15","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.nut.2016.05.016","article-title":"Revisiting the refeeding syndrome: results of a systematic review","volume":"35","author":"Friedli","year":"2017","journal-title":"Nutrition"},{"key":"2025082802005981000_14.11.e244011.16","doi-asserted-by":"crossref","first-page":"2202","DOI":"10.3390\/jcm8122202","article-title":"Management of refeeding syndrome in medical inpatients","volume":"8","author":"Reber","year":"2019","journal-title":"J Clin Med"},{"key":"2025082802005981000_14.11.e244011.17","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1R755"},{"key":"2025082802005981000_14.11.e244011.18","doi-asserted-by":"crossref","first-page":"694","DOI":"10.3109\/19390211.2016.1156208","article-title":"Evidence for, and associated risks with, the human chorionic gonadotropin supplemented diet","volume":"13","author":"Butler","year":"2016","journal-title":"J Diet Suppl"},{"key":"2025082802005981000_14.11.e244011.19","doi-asserted-by":"crossref","first-page":"e511","DOI":"10.7205\/MILMED-D-12-00218","article-title":"A case of refeeding syndrome in a marine recruit","volume":"178","author":"Bunge","year":"2013","journal-title":"Mil Med"},{"key":"2025082802005981000_14.11.e244011.20","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.clnesp.2017.10.003","article-title":"Consequences of an extreme diet in the professional sport: refeeding syndrome to a bodybuilder","volume":"23","author":"Lapinskien\u0117","year":"2018","journal-title":"Clin Nutr ESPEN"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-244011","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:01:12Z","timestamp":1756371672000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-244011"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11]]},"references-count":20,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11,17]]},"published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1136\/bcr-2021-244011"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-244011","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,11]]}}}