Medical and Psychiatric Features of Patients Hospitalized for Severe Restrictive Eating Disorders: Analysis of 545 Consecutive Patients with Severe Anorexia Nervosa or Avoidant/Restrictive Food Intake Disorder

Abstract

BackgroundPeople with severe eating and feeding disorders regularly require hospitalization due to complications inherent to their disease, though formal training regarding this care is limited. MethodsThis retrospective study included 545 patients with severe anorexia nervosa (AN) or avoidant restrictive food intake disorder (ARFID) hospitalized in a medical stabilization unit between 2018 and 2021. Biometrics were obtained throughout hospitalization. Nutrition was increased until patients were gaining 0.2 kg/day. ResultsAverage admission body mass index (BMI) was 13 kg/m2 with diagnoses of 46% AN-R (Restricting), 39% AN-BP (Binge-purge), and 15% ARFID. Average daily Kcals by discharge were 3,343 for females and 3,962 for males; 26% required nasogastric feeding. Hypoglycemia was common until day 7, correlated with elevated liver function tests (LFTs) and low prealbumin. LFTs were abnormal in 31% of patients. Refeeding hypophosphatemia developed in 26% of patients starting day 2 and was associated with lower BMI. Hypokalemia appeared on admission among 39%, twice as common in patients diagnosed with AN-BP. Initial EKGs were abnormal in 50% of patients, usually sinus bradycardia. Average QTc was normal, only 14% prolonged. Bone density testing revealed 70% osteoporosis. History of suicide attempt were present in 19% while 76% and 50% presented with anxiety and depressive disorders respectively. ConclusionsGiven the inextricability of medical complications from severe eating and feeding disorders, familiarity among CL Psychiatrists with the prevalence of frequently observed abnormal findings can inform consultation and prevent adverse events, unnecessary intervention, and facilitate weight restoration and medical stabilization.