Abstract
Background: In mildly to moderately malnourished adolescent patients with anorexia nervosa (AN), accelerated refeeding protocols using higher initial calory supply coupled with phosphate supplements were not associated with a higher incidence of refeeding syndrome (RS). It is unclear whether this is also a feasible approach for extremely malnourished, adult AN patients. Methods: Outcomes of a clinical refeeding protocol involving a targeted initial intake of ≥2000 kcal/day, routine supplementation of phosphate and thiamine as well as close medical monitoring, were evaluated. A retrospective chart review including AN patients with a body mass index (BMI) <13 kg/m² was conducted, to describe changes in weight, BMI, and laboratory parameters (phosphate, creatine kinase, hematocrit, sodium, liver enzymes, and blood count) over four weeks. Results: In 103 female patients (age, mean ± standard deviation (SD) = 23.8 ± 5.3 years), BMI between admission and follow-up increased from 11.5 ± 0.9 to 13.1 ± 1.1 kg/m² and total weight gain within the first four weeks was 4.2 ± 2.0 kg (mean, SD). Laboratory parameter monitoring indicated no case of RS, but continuous normalization of blood parameters. Conclusions: Combined with close medical monitoring and electrolyte supplementation, accelerated refeeding may also be applied to achieve medical stabilization in extremely underweight adults with AN without increasing the risk of RS.
Highlights
Refeeding and Refeeding SyndromeRefeeding syndrome (RS) is a sudden, threatening deterioration in the general physical condition of a cachectic patient undergoing refeeding, especially in the first two to three weeks of refeeding following a prolonged period of hunger
Refeeding causes a change from a catabolic to anabolic metabolism, and concomitant hyperparathyroidism may contribute to the development of hypophosphatemia [6]
Between 01/01/2016 and 12/31/2018, 335 patients were admitted to the 24-bed unit for extremely underweight patients at Schön Klinik Roseneck in Rosenheim, Germany within a 120-bed hospital for psychosomatic medicine and psychotherapy
Summary
Refeeding and Refeeding SyndromeRefeeding syndrome (RS) is a sudden, threatening deterioration in the general physical condition of a cachectic patient undergoing refeeding, especially in the first two to three weeks of refeeding following a prolonged period of hunger. Refeeding causes a change from a catabolic to anabolic metabolism, and concomitant hyperparathyroidism may contribute to the development of hypophosphatemia [6] This process can lead to a critical drop in the intracellular concentration of adenosine triphosphate (ATP) and in the energy supply of the cells [7]. In mildly to moderately malnourished adolescent patients with anorexia nervosa (AN), accelerated refeeding protocols using higher initial calory supply coupled with phosphate supplements were not associated with a higher incidence of refeeding syndrome (RS). It is unclear whether this is a feasible approach for extremely malnourished, adult AN patients. Conclusions: Combined with close medical monitoring and electrolyte supplementation, accelerated refeeding may be applied to achieve medical stabilization in extremely underweight adults with AN without increasing the risk of RS
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