EXCESSIVE LABORATORY MONITORING FOR REFEEDING SYNDROME: OPPORTUNITIES FOR ENHANCEMENT

Abstract

BACKGROUND: Anorexia nervosa (AN) is a complex medical condition affecting mainly adolescents and young adults. Despite the risk of refeeding syndrome, recent literature is supporting more aggressive inpatient nutritional rehabilitation. To aid physicians in monitoring and preventing refeeding syndrome, current guidelines recommend daily laboratory testing in the first week of hospitalization and 2-3times/week for the following 3 weeks. Our hypothesis is that the number of recommended analysis is too important and the cost/benefit could be improved. OBJECTIVES: The aim of this study is first to evaluate the incidence and risk factors of refeeding syndrome in adolescents with AN in a tertiary pediatric center specialized in the treatment of ED, and second to determine the proportion of pertinent blood tests, realized in patients admitted for nutritional rehabilitation, according to their state of malnutrition. DESIGN/METHODS: A retrospective chart review of medical admissions occurring between May 2014 and May 2015 in a tertiary pediatric hospital was performed. Patients were included if they were younger than 18 years old, admitted for protocol-based refeeding (enteral feeding), and met criteria for AN whether restrictive or purging sub-type. For patients with multiple admissions, each admission was analyzed separately. Patients with bulimia nervosa or patients presenting with a pre-existing comorbidity causing electrolyte abnormalities were excluded. Laboratory testing in our setting was done routinely upon admission and then repeated according to the attending physician’s clinical judgment. RESULTS: Of the 99 patient encounters included in the study, the mean age was 14.6 years, with female predominance (97%). The mean admission BMI was 15.3 +/-2 (z-score -2.6+/- 1.4). The mean length of hospitalization was 40.3 days +/- 21.8. No cases of refeeding syndrome were observed. We had 1289 laboratory tests performed, 13 per patient encounter. Of these, only 1.5% were abnormal values (n=16 phosphorus, n=2 magnesium, n=2 potassium) and 0.85% led to supplementation (n=8 phophorus, n=2 magnesium, n= 1 potassium). Patients with abnormal values had similar age, BMI, length of illness and number of hospitalizations compared to patients with normal values. No critical values were identified. The total cost for laboratories performed was 148 926.80$, on average 1504$/admitted patient. CONCLUSION: In our studied population, no cases of refeeding syndrome were observed. Although we performed a lower number of laboratory test than currently recommended without any consequences on outcome or management, we believe there is potential for improvement in those numbers. Further studies are needed to determine the frequency of laboratory testing required to monitor refeeding syndrome.