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 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 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 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 Cardiac Arrest and Successful Extracorporeal Cardiopulmonary Resuscitation as a Result of a Refeeding Syndrome in a Young Female with Anorexia Nervosa

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Daniela Waddell ◽  
Felix Meincke ◽  
Samer Hakmi ◽  
Hendrick van der Schalk ◽  
Niklas Schenker ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Anorexia Nervosa ◽  
Cardiopulmonary Resuscitation ◽  
Young Female ◽  
Left Ventricular ◽  
Refeeding Syndrome ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Severe Left Ventricular Dysfunction ◽  
First Case ◽  
Life Threatening

Anorexia nervosa is a potentially life-threatening eating disorder, characterized by an abnormally low body weight. This case report illustrates a 22-year old female with cardiac arrest due to a refeeding syndrome in a patient with anorexia nervosa. It features the successful use of extracorporeal cardiopulmonary resuscitation in a case of severe left ventricular dysfunction resulting in a favorable outcome. Conclusion. We present the first case of a cardiac arrest due to a refeeding syndrome in anorexia nervosa featuring the successful use of an extracorporeal cardiopulmonary resuscitation approach as a bridge to full recovery.

scholarly journals Disrupted Oxytocin-Appetite Signaling in Females With Anorexia Nervosa

2019 ◽  
Vol 104 (10) ◽  
pp. 4931-4940 ◽  
Author(s):  
Anna Aulinas ◽  
Franziska Plessow ◽  
Reitumetse L Pulumo ◽  
Elisa Asanza ◽  
Christopher J Mancuso ◽  
...  
Keyword(s):  
Body Weight ◽  
Anorexia Nervosa ◽  
Caloric Intake ◽  
Mixed Meal ◽  
Cross Sectional ◽  
Visual Analog Scales ◽  
Clinical Research Center ◽  
Postprandial Response ◽  
Endogenous Estrogen ◽  
Healthy Females

Abstract Context In healthy females, oxytocin levels decrease postmeal, corresponding to increased satiety. The postprandial response of oxytocin in females with anorexia nervosa (AN)/atypical AN is unknown. Objectives To determine the pattern of postprandial serum oxytocin levels in females with AN/atypical AN, relationship with appetite, and effect of weight, eating behavior, and endogenous estrogen status. Design Cross-sectional. Setting Clinical research center. Participants 67 women (36 with AN [<85% expected body weight (EBW)]; 31 with atypical AN [≥ 85% EBW)]), age 22.4 ± 0.9 (mean ± SEM) years, categorized by weight, restricting vs binge/purge behavior, and estrogen status. Interventions Standardized mixed meal. Main Outcome Measurements Blood sampling for oxytocin occurred fasting and 30, 60, and 120 minutes postmeal. Subjective appetite was assessed using visual analog scales. Results In females with AN/atypical AN, oxytocin levels decreased from fasting to 60 (P = 0.002) and 120 (P = 0.005) minutes postmeal. The decrease in oxytocin from fasting to 120 minutes was greater in females with atypical AN than AN (P = 0.027) and did not differ by restricting vs binge/purge behavior or estrogen status. Controlling for caloric intake, the decrease in oxytocin was inversely related to the decrease in hunger postmeal in females with atypical AN (P = 0.04). Conclusions In females with AN/atypical AN, oxytocin levels decrease postmeal, as established in healthy females. Weight, but not restricting vs binge/purging nor endogenous estrogen status, affects postprandial oxytocin levels. The postprandial change in serum oxytocin levels is related to appetite in females with atypical AN only, suggesting a disconnect between oxytocin secretion and appetite in the undernourished state.

scholarly journals Anorexia Nervosa and Refeeding Syndrome. A Case Report

2007 ◽  
Vol 7 ◽  
pp. 400-403 ◽  
Author(s):  
Kohji Azumagawa ◽  
Yukiko Kambara ◽  
Naohisa Kawamura ◽  
Yoshito Takenaka ◽  
Takeshi Yamasaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Body Weight ◽  
Anorexia Nervosa ◽  
Medical Treatment ◽  
Severe Liver ◽  
Refeeding Syndrome ◽  
Careful Treatment ◽  
Severe Liver Damage ◽  
Ideal Body

This is a case story of a 14-year-old girl with severe anorexia nervosa (AN) (158 cm, 28 kg, –44.1% ideal body mass index), admitted with purpura, edema, and general fatigue. We treated her carefully and paid particular attention to prevent development of refeeding syndrome (RS), and her body weight increased satisfactorily. However, RS (edema, hypoalbuminemia, and heart failure) occurred despite careful treatment. We used albumin and diuretics for treatment of RS, but severe liver damage resulted. RS was aggravated by the medical treatment. More attention should have been paid to her weight gain and medical treatment should have been initiated more slowly to prevent dramatic changes in the patient's fluid and electrolyte status.

scholarly journals A Retrospective Analysis Evaluating the Outcome of Parenteral Nutrition in the Treatment of Anorexia Nervosa in Korea

2020 ◽  
Vol 9 (11) ◽  
pp. 3711
Author(s):  
Jeong-Kyung Ko ◽  
You-Kyung Lee ◽  
Jong Chun Na ◽  
Dong-Yeon Kim ◽  
Youl-Ri Kim
Keyword(s):  
Anorexia Nervosa ◽  
Weight Gain ◽  
Parenteral Nutrition ◽  
Early Stage ◽  
Caloric Intake ◽  
Tube Feeding ◽  
Average Hospital ◽  
Weight Gains ◽  
Similar Weight ◽  
Nasogastric Tube Feeding

The objective of this study was to investigate the clinical efficacy of parenteral nutrition (PN) as supplemental feeding for patients with anorexia nervosa (AN). This study was conducted by reviewing the medical records of patients with AN who were hospitalized at a non-specialized ward. A total of 129 patients with AN were recruited, consisting of 67 patients received PN with oral refeeding and 62 patients received oral refeeding alone. We compared the weight gain at discharge and after discharge between the groups. As a result, at admission, the patients given supplementary PN had lower body mass indices and lower caloric intake than the patients without PN. The mean duration of PN was 8.5 days, which amounted to about a third of the average hospital stay with no difference between the groups. Both groups had similar weight gains during hospitalization, but the patients with PN had higher weight gains than the patients without PN at one and three months after discharge. In conclusion, the results suggest that supplementary PN in the early stage of refeeding might initiate weight gain in AN when nasogastric tube feeding is not possible. Randomized controlled trials are needed to be further tested of PN in treatment of AN.

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