Background: Refeeding Syndrome (RS) is an under-recognised pathophysiological process that can result in arrhythmias, coma and death if not identified and managed appropriately. Case Presentation This case report discusses RS in a 77 year-old female who presented with six days of total anorexia secondary to abdominal pain and vomiting. The patient was identified to have an ischaemic closed loop obstruction of the small bowel in the right femoral hernia with associated proximal small bowel obstruction. Following a small bowel resection, nutrition was reintroduced where on day three the patient developed hypophosphatemia, the hallmark of RS. Conclusion This case highlights the importance of considering RS in patients with a seemingly short duration of starvation due to acute intercurrent illness such as in this case a small bowel obstruction.

Keywords: Refeeding syndrome, hypophosphatemia, starvation, acute illness, small bowel obstruction, emergency medicine, intensive care