Table 1.

Differentiation points between starvation hepatitis and refeeding-induced hepatitis

Characteristic	Starvation hepatitis	Refeeding-induced hepatitis
Pathogenesis	Aberrant autophagy activation Hypovolemia-induced liver hypoxia	Hepatic fat and glycogen deposition
Clinical picture	Severe hypoglycaemia, arrhythmia including bradycardia, oedema hypothermia, hypotension, amenorrhea (in females), and coma	Generally asymptomatic, hypophosphatemia, hypokalemia, and hypomagnesaemia. In severe cases, oedema, cardiac dysfunction, and neurological changes
Risk of onset and BMI	BMI < 12 kg/m2	BMI < 16 kg/m2
Serum transaminase levels	Severe increase	Mild increase
Imaging studies	The liver can be normal or small	The liver is enlarged and fatty
Histopathology of the liver	Mild lobular inflammation and glycogen depletion in the cytoplasm of the oedematous hepatocytes (sign of autophagy). Necrosis and apoptosis are not evident	Fatty liver with moderate portal inflammation, ballooning of hepatocytes, and increased glycogen deposits
Principles of treatment	Restorations of adequate caloric replenishment. Careful rehydration	Reduction of nutritional support; gradual rehydration; supplementation with thiamine, potassium, phosphate, and magnesium