Refeeding Syndrome in Incarcerated Individuals With Opioid Use Disorder: A Case Study

Refeeding syndrome is a serious metabolic complication that can occur when nutrition is reintroduced after periods of malnutrition, yet it remains underrecognized outside traditional clinical settings. Individuals with opioid use disorder (OUD) may be particularly susceptible due to chronic nutritional deficiencies, irregular eating patterns, and recent caloric deprivation—risks that may be intensified during incarceration. This case describes a 30-year-old incarcerated male with OUD who presented to the emergency department with seizures, severe metabolic acidosis, cardiac arrhythmia, and profound electrolyte abnormalities shortly after intake. The case highlights the diagnostic challenges of recognizing refeeding syndrome in justice-involved populations, where symptoms can overlap with withdrawal, sepsis, or other acute medical conditions. It further illustrates how even brief periods of nutritional restriction followed by unregulated feeding in custody settings can precipitate life-threatening metabolic consequences. Beyond its clinical implications, this case underscores the intersection of correctional health and public health and the role of both healthcare and custody professionals in identifying risk and supporting safe nutritional practices.