Nutritional rehabilitation of anorexia nervosa. Goals and dangers.
Nutritional rehabilitation of adolescents with anorexia nervosa is both a science and an art. The goals are to promote metabolic recovery; restore a healthy body weight; reverse the medical complications of the disorder and to improve eating behaviors and psychological functioning. Most, but not all of the medical complications are reversible with nutritional rehabilitation. Refeeding patients with anorexia nervosa results in deposition of lean body mass initially, followed by restoration of adipose tissue as treatment goal weight is approached. The major danger of nutritional rehabilitation is the refeeding syndrome, characterized by fluid and electrolyte, cardiac, hematological and neurological complications, the most serious of which is sudden unexpected death. The refeeding syndrome is most likely to occur in those who are severely malnourished. In such patients, this complication can be avoided by slow refeeding with careful monitoring of body weight, heart rate and rhythm and serum electrolytes, especially serum phosphorus. This paper reviews our clinical experience.
Golden
Neville H
NH
Schneider Children's Hospital, Division of Adolescent Medicine, Long Island Jewish Medical Center, New Hyde Park, New York 11040, United States of America. golden@lij.edu
Meyer
Wendy
W
D000293:Adolescent; D017195:Adolescent Nutritional Physiological Phenomena; D000855:Anorexia / Q000150:complications / Q000178:diet therapy* / Q000534:rehabilitation; D001823:Body Composition; D005248:Feeding Methods / Q000009:adverse effects*; D006801:Humans; D013577:Syndrome; D014481:United States