scholarly journals To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol

Nutrients ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 229
Author(s):  
Stephanie Proulx-Cabana ◽  
Marie-Elaine Metras ◽  
Danielle Taddeo ◽  
Olivier Jamoulle ◽  
Jean-Yves Frappier ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Caloric Intake ◽  
Tube Feeding ◽  
Narrative Review ◽  
Cardiac Monitoring ◽  
Current Evidence ◽  
Cardiac Complications ◽  
Nutritional Rehabilitation ◽  
Refeeding Syndrome ◽  
Pubmed Search

Inadequate nutritional rehabilitation of severely malnourished adolescents with Anorexia Nervosa (AN) increases the risk of medical complications. There is no consensus on best practices for inpatient nutritional rehabilitation and medical stabilization for severe AN. This study aimed to elaborate an admission protocol for adolescents with severe AN based on a comprehensive narrative review of current evidence. A Pubmed search was conducted in July 2017 and updated in August 2020, using the keywords severe AN or eating disorders (ED), management guidelines and adolescent. Relevant references cited in these guidelines were retrieved. A secondary search was conducted using AN or ED and refeeding protocol, refeeding syndrome (RS), hypophosphatemia, hypoglycemia, cardiac monitoring or cardiac complications. Evidence obtained was used to develop the admission protocol. Selective blood tests were proposed during the first three days of nutritional rehabilitation. Higher initial caloric intake is supported by evidence. Continuous nasogastric tube feeding was proposed for patients with a BMI < 12 kg/m2. We monitor hypoglycemia for 72 h. Continuous cardiac monitoring for bradycardia <30 BPM and systematic phosphate supplementation should be considered. Developing protocols is necessary to improve standardization of care. We provide an example of an inpatient admission protocol for adolescents with severe AN.

scholarly journals Anorexia Nervosa—What Has Changed in the State of Knowledge about Nutritional Rehabilitation for Patients over the Past 10 Years? A Review of Literature

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 3819
Author(s):  
Katarzyna Jowik ◽  
Marta Tyszkiewicz-Nwafor ◽  
Agnieszka Słopień
Keyword(s):  
Anorexia Nervosa ◽  
Healing Process ◽  
Caloric Intake ◽  
Current Treatment ◽  
Review Of Literature ◽  
Nutritional Rehabilitation ◽  
Long Term Effects ◽  
Refeeding Syndrome ◽  
The Past ◽  
Potential Benefits

Anorexia nervosa (AN) is a psycho-metabolic disorder with a high risk of somatic complications such as refeeding syndrome (RFS) and carries the highest mortality rate of all psychiatric illnesses. To date, the consensus on the care for patients with AN has been based on recommendations for a combination of alimentation and psychotherapy. It is important to establish an initial caloric intake that will provide weight gain and minimize the risk of complications in the treatment of undernourished patients. Research over the past few years suggests that current treatment recommendations may be too stringent and should be updated. The aim of this paper is to systematize the current reports on nutritional rehabilitation in AN, to present the results of studies on the safe supplementation of patients and its potential impact on improving prognosis and the healing process. This review of literature, from 2011–2021, describes the changing trend in the nutritional protocols used and the research on their efficacy, safety, and long-term effects. In addition, it presents previous reports on the potential benefits of introducing vitamin, pro-and prebiotic and fatty acid supplementation.

scholarly journals Metabolic and Nutritional Needs to Normalize Body Mass Index by Doubling the Admission Body Weight in Severe Anorexia Nervosa

2013 ◽  
Vol 6 ◽  
pp. CCRep.S11471 ◽  
Author(s):  
Maria Gabriella Gentile ◽  
Chiara Lessa ◽  
Marina Cattaneo
Keyword(s):  
Body Weight ◽  
Anorexia Nervosa ◽  
Clinical Laboratory ◽  
Psychiatric Patients ◽  
Caloric Intake ◽  
Tube Feeding ◽  
Young Female ◽  
Refeeding Syndrome ◽  
Nutritional Needs ◽  
Electrolyte Abnormalities

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/m2) 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.

scholarly journals Higher Caloric Refeeding Is Safe in Hospitalised Adolescent Patients with Restrictive Eating Disorders

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Elizabeth K. Parker ◽  
Sahrish S. Faruquie ◽  
Gail Anderson ◽  
Linette Gomes ◽  
Andrew Kennedy ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Weight Gain ◽  
Statistical Significance ◽  
Caloric Intake ◽  
Tube Feeding ◽  
Retrospective Chart Review ◽  
Refeeding Syndrome ◽  
Restrictive Eating ◽  
Weight Restoration ◽  
The Mean

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.

scholarly journals A case of refeeding syndrome in pregnancy with anorexia nervosa

2017 ◽  
Vol 11 (2) ◽  
pp. 95-97 ◽  
Author(s):  
Hiroaki Soyama ◽  
Morikazu Miyamoto ◽  
Takahiro Natsuyama ◽  
Masashi Takano ◽  
Hidenori Sasa ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Cesarean Section ◽  
Calorie Restriction ◽  
Caloric Intake ◽  
Primiparous Woman ◽  
Refeeding Syndrome ◽  
Additional Risk ◽  
Severe Fatigue ◽  
Electrolyte Replacement ◽  
In Pregnancy

Refeeding syndrome very rarely develops during pregnancy. A 35-year-old primiparous woman pregnant with twins complained of severe fatigue at 19 weeks’ gestation. She was admitted to our hospital in a malnourished condition because of repeated self-induced vomiting due to anorexia nervosa. Just after hospitalization, she voluntarily increased her caloric intake significantly above the recommended prescribed diet, without medical permission. Nine days later, she developed refeeding syndrome. Electrolyte replacement and calorie restriction were started and her condition gradually improved. The healthy twin babies were born by cesarean section at 36 weeks’ gestation. Acute increases in caloric intake by previously malnourished pregnant women with anorexia nervosa may induce refeeding syndrome. Women with the binge eating/purging subtype of anorexia nervosa may be at additional risk due to alternating phases of starvation and overeating.

scholarly journals Effects of Diaphragmatic Breathing on Health: A Narrative Review

Medicines ◽  
2020 ◽  
Vol 7 (10) ◽  
pp. 65
Author(s):  
Hidetaka Hamasaki
Keyword(s):  
Functional Constipation ◽  
Treatment Method ◽  
Poor Quality ◽  
Narrative Review ◽  
Current Evidence ◽  
Chronic Obstructive ◽  
Diaphragmatic Breathing ◽  
Obstructive Pulmonary Disease ◽  
Pubmed Search

Background: Breathing is an essential part of life. Diaphragmatic breathing (DB) is slow and deep breathing that affects the brain and the cardiovascular, respiratory, and gastrointestinal systems through the modulation of autonomic nervous functions. However, the effects of DB on human health need to be further investigated. Methods: The author conducted a PubMed search regarding the current evidence of the effect of DB on health. Results: This review consists of a total of 10 systematic reviews and 15 randomized controlled trials (RCTs). DB appears to be effective for improving the exercise capacity and respiratory function in patients with chronic obstructive pulmonary disease (COPD). Although the effect of DB on the quality of life (QoL) of patients with asthma needs to be investigated, it may also help in reducing stress; treating eating disorders, chronic functional constipation, hypertension, migraine, and anxiety; and improving the QoL of patients with cancer and gastroesophageal reflux disease (GERD) and the cardiorespiratory fitness of patients with heart failure. Conclusions: Based on this narrative review, the exact usefulness of DB in clinical practice is unclear due to the poor quality of studies. However, it may be a feasible and practical treatment method for various disorders.

scholarly journals Skeletal effects and refeeding syndrome in anorexia nervosa

2020 ◽  
pp. 585-587
Author(s):  
Naomi VĂDUVA ◽  
Lehel PUSKAS ◽  
Andreea-Liana RĂCHIȘAN ◽  
Anamaria Magdalena TOMȘA ◽  
Andreea Alexandra ALDEA ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Therapeutic Approach ◽  
Nutritional Support ◽  
Nutritional Rehabilitation ◽  
Key Factors ◽  
Refeeding Syndrome ◽  
Laboratory Findings ◽  
Life Threatening ◽  
Weight Restoration ◽  
Skeletal Effects

Purpose Anorexia nervosa (AN) is a psychiatric disorder which can lead to numerous medical complications. In the clinical practice, during weight restoration, it is relatively common to observe potentially fatal complications, such as refeeding syndrome (RS). The objective of this case report is to highlight some key factors regarding nutritional support and the therapeutic approach in AN to avoid life-threatening complications, for example severe hypophosphatemia. Methods We present the case of a 14-year-old girl suffering from AN, who was admitted to our hospital with lethargy, emaciation with bitemporal wasting, hirsutism and pitting lower extremity edema. Results Based on the laboratory findings, the concerning condition of the patient was attributed to hypophosphatemia (1,64 mg/dl) caused by RS. Conclusions Refeeding syndrome is a potentially lethal condition in the case of AN patients. Hypophosphatemia, which is a result of the refeeding syndrome, is a relatively common complication of overly aggressive nutritional rehabilitation. Physicians who are involved in treating this condition, should be aware of this potentially life-threatening syndrome, and assess their therapeutic approach accordingly Keywords: anorexia nervosa, hypophosphatemia, refeeding syndrome, nutritional support,

scholarly journals Gastrointestinal Complications of Refeeding in Anorexia Nervosa

2016 ◽  
Vol 2 (1) ◽  
Author(s):  
Nathalia Marie Trees
Keyword(s):  
Anorexia Nervosa ◽  
Delayed Gastric Emptying ◽  
Medical Complications ◽  
Nutritional Rehabilitation ◽  
Refeeding Syndrome ◽  
Gastrointestinal Complications ◽  
Nutrition Rehabilitation ◽  
Life Threatening ◽  
Weight Restoration ◽  
Eating Disorder Behaviors

Anorexia nervosa (AN) is a complicated and life-threatening mental illness. Restoration of weight and nutrition rehabilitation are key elements for the treatment of AN. However, gastrointestinal (GI) complications often develop due to eating disorder behaviors, concomitant malnutrition, and during the refeeding process. These problems may give rise to significant medical complications and contribute to increased difficulties with refeeding and weight restoration. This review aims to describe common GI complications in AN including delayed gastric emptying, gastric dilatation, superior mesenteric artery (SMA) syndrome, refeeding hepatitis, and refeeding syndrome. Recommendations for clinicians refeeding a patient with AN are provided. Knowledge of these GI manifestations is required for correct management and successful nutritional rehabilitation of patients with AN.

Newer Approaches to Acute Nutritional Rehabilitation for Patients With Anorexia Nervosa

2018 ◽  
pp. 344-358
Author(s):  
Andrea K. Garber ◽  
Michael Kohn
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Standard Approach ◽  
Nutritional Rehabilitation ◽  
Refeeding Syndrome ◽  
Restrictive Eating ◽  
Wide Variability

Refeeding in the hospital is recommended for patients with malnutrition and medical instability secondary to restrictive eating disorders. For decades, the standard approach to refeeding was lower calorie diets, aimed at minimizing risk for the refeeding syndrome. Emerging data indicate that this approach may be too conservative, and that higher calorie refeeding is feasible. This approach is being rapidly translated into practice with wide variability in routes of delivery and electrolyte correction. This article reviews the current research on refeeding, with particular attention to gaps in the evidence that must be filled before new refeeding recommendations can be developed.

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