Complications of emergency refeeding in anorexia nervosa: Case series and review

Department of Gastroenterology, Royal Berkshire NHS Foundation Trust, Reading, UK.
Acute medicine 01/2011; 10(2):69-76.
Source: PubMed


The refeeding syndrome is common among patients with anorexia nervosa. It may be lethal and has many manifestations. We report a case series of 14 anorexic patients admitted for feeding to a single British centre. There was a high prevalence of the refeeding syndrome, with three cases requiring higher dependency unit support and one death. We present a review of the refeeding syndrome in anorectics and highlight our impression that infection among such patients may be serious and under-recognised.

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Available from: Gwilym J Webb, May 10, 2014
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    ABSTRACT: Anorexia nervosa exhibits one of the highest death rates among psychiatric patients and a relevant fraction of it is derived from undernutrition. Nutritional and medical treatment of extreme undernutrition present two very complex and conflicting tasks: (1) to avoid "refeeding syndrome" caused by a too fast correction of malnutrition; and (2) to avoid "underfeeding" caused by a too cautious refeeding. To obtain optimal treatment results, the caloric intake should be planned starting with indirect calorimetry measurements and electrolyte abnormalities accurately controlled and treated. This article reports the case of an anorexia nervosa young female affected by extreme undernutrition (BMI 9.6 kg/m(2)) who doubled her admission body weight (from 22.5 kg to 44 kg) in a reasonable time with the use of enteral tube feeding for gradual correction of undernutrition. Refeeding syndrome was avoided through a specialized and flexible program according to clinical, laboratory, and physiological findings.
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    ABSTRACT: Refeeding syndrome (RFS) broadly encompasses a severe electrolyte disturbance (principally low serum concentrations of intracellular ions such as phosphate, magnesium and potassium) and metabolic abnormalities in under-nourished patients undergoing refeeding whether orally, enterally, or parenterally; RFS reflects the change from catabolic to anabolic metabolism. The RFS sometimes is undiagnosed and unfortunately some clinicians remain oblivious to its presence. This is particularly concerning as RFS is a life threatening condition although it need not be so and early recognition reduces morbidity and mortality. Careful patient monitoring and multi-discipline nutrition team management may help to achieve this goal. The diagnosis of RFS is not facilitated by the fact that there is no universal agreement as to its definition. The presence of hypophosphataemia alone does not necessarily mean that the RFS is present as there are many other causes for this as I discuss later in this article. The RFS is increasingly being recognised in neonates and children. An optimal refeeding regime for RFS is not universally agreed due to paucity of randomised controlled trials in the field.
    Nutrition 11/2014; 30(11-12). DOI:10.1016/j.nut.2014.03.026 · 2.93 Impact Factor