Impact of caloric prescriptions and degree of malnutrition on incidence of refeeding syndrome and clinical outcomes in patients with eating disorders: A retrospective review

Introduction. This study examines weight gain and assesses complications associated with refeeding hospitalised adolescents with restrictive eating disorders (EDs) prescribed initial calories above current recommendations.Methods. Patients admitted to an adolescent ED structured “rapid refeeding” program for >48 hours and receiving ≥2400 kcal/day were included in a 3-year retrospective chart review.Results. The mean (SD) age of the 162 adolescents was 16.7 years (0.9), admission % median BMI was 80.1% (10.2), and discharge % median BMI was 93.1% (7.0). The mean (SD) starting caloric intake was 2611.7 kcal/day (261.5) equating to 58.4 kcal/kg (10.2). Most patients (92.6%) were treated with nasogastric tube feeding. The mean (SD) length of stay was 3.6 weeks (1.9), and average weekly weight gain was 2.1 kg (0.8). No patients developed cardiac signs of RFS or delirium; complications included 4% peripheral oedema, 1% hypophosphatemia (<0.75 mmol/L), 7% hypomagnesaemia (<0.70 mmol/L), and 2% hypokalaemia (<3.2 mmol/L). Caloric prescription on admission was associated with developing oedema (95% CI 1.001 to 1.047;p=0.039). No statistical significance was found between electrolytes and calories provided during refeeding.Conclusion. A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome.

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POD-6.01: A Retrospective Review of Renal Ablative Therapies for Renal Masses: Clinical Outcomes

Urology ◽

10.1016/j.urology.2008.08.117 ◽

2008 ◽

Vol 72 (5) ◽

pp. S50

Author(s):

M. Dhar ◽

R. Kozak ◽

J. Amann ◽

L. Nott ◽

S. Pautler

Keyword(s):

Clinical Outcomes ◽

Retrospective Review ◽

Renal Masses ◽

Ablative Therapies

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Improving knowledge and confidence in the acute management of eating disorders and resulting complications

BJPsych Open ◽

10.1192/bjo.2021.503 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S186-S186

Author(s):

Sarah Fynes-Clinton ◽

Clare Price ◽

Louisa Beckford ◽

Maisha Shahjahan ◽

Brendan McKeown

Keyword(s):

Eating Disorders ◽

Clinical Information ◽

Easy Access ◽

Average Score ◽

Junior Doctors ◽

Refeeding Syndrome ◽

Improvement Project ◽

Positive Effects ◽

The Creation ◽

The Impact

AimsThis project aimed to improve the knowledge and confidence of doctors at all levels when managing patients with eating disorders while on call.BackgroundA recent survey found just 1% of doctors have the opportunity for clinical experience on eating disorders. Anecdotally, a number of junior doctors within our trust had mentioned that they felt unsure when asked to manage patients with eating disorders during their out of hours shifts.MethodThis project aimed to ascertain levels of confidence with managing patients with eating disorders, and to collect suggestions to improve this. This was achieved using a survey sent out to 97 doctors working in a Mental Health Trust.We then utilised two of the suggestions to improve the identified areas of concern. The first method involved direct lectures. This was followed up with the creation of a poster highlighting the pertinent information which was displayed in key clinical areas. The second avenue was the creation of an information booklet covering key clinical information that is available to all on call doctors.ResultThe response rate for the survey was 37.11%. The survey found that doctors lacked confidence in the management of common conditions that arise in patients admitted with eating disorders. Refeeding syndrome was identified as the greatest area of concern by responding doctors.To assess the impact of the lectures, MCQs were given out before and after the presentation. The results were compared, and showed a clear improvement in overall knowledge, with results going from an average score of 56.6% to 80%.ConclusionBy using multiple methods to improve doctors confidence, (lectures, written information and visual posters), this quality improvement project achieved its aims in improving doctors knowledge, and through having easy access to important information, will have long term positive effects on patient care.

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652 – Clinical Outcomes in Australian Children with Cystic Fibrosis Liver Disease: A Nationwide Retrospective Review with Matched Controls

Gastroenterology ◽

10.1016/s0016-5085(19)37132-x ◽

2019 ◽

Vol 156 (6) ◽

pp. S-136-S-137

Author(s):

Harveen Singh ◽

Michael J. Coffey ◽

Chee Yee Ooi

Keyword(s):

Cystic Fibrosis ◽

Liver Disease ◽

Clinical Outcomes ◽

Retrospective Review

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Avoiding deaths in hospital from anorexia nervosa: the MARSIPAN project

The Psychiatrist ◽

10.1192/pb.bp.111.036699 ◽

2012 ◽

Vol 36 (3) ◽

pp. 109-113 ◽

Cited By ~ 7

Author(s):

Paul Robinson

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Adult Patients ◽

Refeeding Syndrome ◽

The Family ◽

Key Issues ◽

Medical Teams ◽

Medical Wards

SummaryThe MARSIPAN (MAnagement of Really SIck Patients with Anorexia Nervosa) project was established in response to reports of patients admitted to medical wards and proving refractory to treatment, sometimes dying on the ward. Psychiatrists, physicians and other clinicians in nutrition and eating disorders were brought together to discuss key issues in the assessment and management of such patients. The resulting guidance report, which applies to adult patients over 18, addresses: assessment of risk, where to treat the patient, specialist support for medical teams, key elements of treatment, namely (a) safe refeeding to avoid refeeding syndrome and underfeeding syndrome, (b) management of problematic behaviours, (c) support for the family, and (d) transfer to a specialist eating disorder unit when appropriate and possible.

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