[Anorexia nervosa with refeeding syndrome: prevention and treatment of RS].
Refeeding syndrome (RS), seen in the early stages of anorexia nervosa (AN) treatment, has not been paid sufficient attention regarding its strong association with poor outcomes. This report describes a case of AN restriction type (AN-R) with sequent RS appearance despite the introduction of progressive and careful low-calorie nutrition, and discusses RS treatment. The patient was a 16-year-old female. She was first diagnosed with AN at the age of 14 when she went on a diet, admitted into pediatrics, and recovered: however, AN recurred after she started high school, and her weight decreased to 31.8 kg. She was admitted to pediatrics again, refused to receive treatment, discharged from the hospital, and introduced to our department. Soon after she came to us, her weight went down to 29.6 kg, and continued to decrease to 26.8 kg. She was recommended to receive inpatient care, but she firmly refused. A few days later, her experience of loss of consciousness made her agree to receive inpatient care. At this time, she was already weakened and had difficulty performing voluntary body movements as well as excretion. She was treated carefully and placed on 125 kcal/day. On the 6th day of treatment, severe liver damage was observed, her serum phosphorus level went down to 2.0 mg/dL, and she was diagnosed with RS. The lowest concentration of serum phosphorus observed was 1.3 mg/dL with blood abnormality and delirium; however, our strict management with intravascular phosphorus administration supported her increased dietary intake, and the patient was able to leave the hospital on the 54th day after admission. Based on this experience, the pathogenesis of RS was overviewed, and RS prevention as well as treatment was discussed. It has been reported that low phosphorus levels are observed in approximately one quarter of AN patients, and, thus, immediate action and treatment of hypophosphatemia are necessary when considering RS occurrence. In this study, the observed serum phosphorus concentration was higher than the general reported values; however, it is critical to pay attention to any quick drop in the serum phosphorus level rather than the absolute value. Also, as a preventative method, it is important to start the treatment before the patient's situation becomes critical. Since eating disorders are classified as psychiatric disorders, treatments under involuntary hospital admission should be allowed to avoid the worst situation. The following are suggestions to justify protective hospital admissions for such cases and their minimal requirements. Such actions should be taken for patients who are significantly underweight or in a critical health condition due to sudden weight loss. It is easier for patients to adapt to the treatment when the condition is new-onset or short disorder duration cases before they become chronic problems. After the caregiver-patient medical care relationship has been forget and significant effort has been made to get the patient to agree to treatment, compulsory treatment should be implemented in cases in which patients do not agree to treatment to avoid life-threatening situations.
Kasai
Makiko
M
Department of Psychiatry, Jichi Medical University.
Okajima
Yoshirou
Y
Takano
Eisuke
E
Kato
Satoshi
S
D000293:Adolescent; D000856:Anorexia Nervosa / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D055677:Refeeding Syndrome / Q000209:etiology* / Q000628:therapy