title: Use of total parenteral nutrition in the refeeding of selected patients with severe anorexia nervosa.
abstract: OBJECTIVE
  At present there is no consensus on how to refeed patients with severe anorexia nervosa. In these case reports, we describe two patients beset with gastrointestinal comorbidities which impaired their ability to refeed with a staged oral feeding program. The use of total parenteral nutrition (TPN) facilitated their recovery.
  
  
  METHODS
  We present two cases of severe anorexia nervosa, complicated by comorbid gastrointestinal disorders, which precluded them from successful refeeding using oral food calories. The treatment with TPN consisted of using a surgically placed, indwelling tunneled catheter to deliver progressively increased amounts of intravenous calories. This facilitated successful weight restoration.
  
  
  CONCLUSIONS
  Although most patients with anorexia nervosa should be refed with a dietary program which is based on progressive increases in oral calories, TPN should be judiciously considered for patients with severe anorexia nervosa who also have medical comorbidities which preclude the usage of this standard approach.
authors.affiliation: Department of Internal Medicine, Denver Health Medical Center, Denver, Colorado, USA. pmehler@dhha.org
authors.forename: Philip S
authors.initials: PS
authors.lastname: Mehler
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Weiner
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007441:Intubation, Gastrointestinal; D010289:Parenteral Nutrition, Total; D018579:Patient Selection