Nutritional rehabilitation: practical guidelines for refeeding the anorectic patient.
Weight restoration is crucial for successful treatment of anorexia nervosa. Without it, patients may face serious or even fatal medical complications of severe starvation. However, the process of nutritional rehabilitation can also be risky to the patient. The refeeding syndrome, a problem of electrolyte and fluid shifts, can cause permanent disability or even death. It is essential to identify at-risk patients, to monitor them carefully, and to initiate a nutritional rehabilitation program that aims to avoid the refeeding syndrome. A judicious, slow initiation of caloric intake, requires daily management to respond to entities such as liver inflammation and hypoglycemia that can complicate the body's conversion from a catabolic to an anabolic state. In addition, nutritional rehabilitation should take into account clinical characteristics unique to these patients, such as gastroparesis and slowed colonic transit, so that measures can be taken to ameliorate the physical discomforts of weight restoration. Adjunct methods of refeeding such as the use of enteral or parenteral nutrition may play a small but important role in a select patient group who cannot tolerate oral nutritional rehabilitation alone.
Mehler
Philip S
PS
Department of Internal Medicine, Denver Health Medical Center, Denver, CO 80204, USA.
Winkelman
Amy B
AB
Andersen
Debbie M
DM
Gaudiani
Jennifer L
JL
J Dev Behav Pediatr. 2004 Dec;25(6):415-8
15613990
Int J Eat Disord. 1995 May;17(4):337-45
7620473
J Adolesc Health. 2003 Jan;32(1):83-8
12507806
Aust N Z J Psychiatry. 2004 Oct;38(10):819-29
15369541
J Neuropsychiatry Clin Neurosci. 2008 Summer;20(3):371-3
18806246
Clin Nutr. 2007 Feb;26(1):100-6
17045705
J Adolesc Health. 2004 Apr;34(4):300-7
15040999
Am J Clin Nutr. 2004 Dec;80(6):1469-77
15585757
Eur J Clin Nutr. 2008 Jun;62(6):687-94
17700652
Int J Eat Disord. 2001 Jul;30(1):69-74
11439410
J Adolesc Health. 2008 Feb;42(2):111-8
18207088
JPEN J Parenter Enteral Nutr. 1990 Jan-Feb;14(1):90-7
2109122
J Am Diet Assoc. 2006 Dec;106(12):2073-82
17186637
Int J Eat Disord. 2007 Apr;40(3):285-7
17262814
Eat Disord. 2004 Summer;12(3):251-6
16864322
J Adolesc Health Care. 1988 Jan;9(1):15-21
3335466
Int J Eat Disord. 2004 Jul;36(1):22-30
15185268
Int J Eat Disord. 2005 Mar;37(2):175-7
15732067
Ann Clin Psychiatry. 2006 Apr-Jun;18(2):123-7
16754418
BMJ. 2004 Jun 12;328(7453):1407
15175229
Int J Eat Disord. 1993 Nov;14(3):297-304
8275066
BMJ. 2008 Jun 28;336(7659):1495-8
18583681