title: Nutritional rehabilitation: practical guidelines for refeeding the anorectic patient.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Denver Health Medical Center, Denver, CO 80204, USA.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Mehler
authors.forename: Amy B
authors.initials: AB
authors.lastname: Winkelman
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Andersen
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Gaudiani
references.citation: J Dev Behav Pediatr. 2004 Dec;25(6):415-8
references.pmid: 15613990
references.citation: Int J Eat Disord. 1995 May;17(4):337-45
references.pmid: 7620473
references.citation: J Adolesc Health. 2003 Jan;32(1):83-8
references.pmid: 12507806
references.citation: Aust N Z J Psychiatry. 2004 Oct;38(10):819-29
references.pmid: 15369541
references.citation: J Neuropsychiatry Clin Neurosci. 2008 Summer;20(3):371-3
references.pmid: 18806246
references.citation: Clin Nutr. 2007 Feb;26(1):100-6
references.pmid: 17045705
references.citation: J Adolesc Health. 2004 Apr;34(4):300-7
references.pmid: 15040999
references.citation: Am J Clin Nutr. 2004 Dec;80(6):1469-77
references.pmid: 15585757
references.citation: Eur J Clin Nutr. 2008 Jun;62(6):687-94
references.pmid: 17700652
references.citation: Int J Eat Disord. 2001 Jul;30(1):69-74
references.pmid: 11439410
references.citation: J Adolesc Health. 2008 Feb;42(2):111-8
references.pmid: 18207088
references.citation: JPEN J Parenter Enteral Nutr. 1990 Jan-Feb;14(1):90-7
references.pmid: 2109122
references.citation: J Am Diet Assoc. 2006 Dec;106(12):2073-82
references.pmid: 17186637
references.citation: Int J Eat Disord. 2007 Apr;40(3):285-7
references.pmid: 17262814
references.citation: Eat Disord. 2004 Summer;12(3):251-6
references.pmid: 16864322
references.citation: J Adolesc Health Care. 1988 Jan;9(1):15-21
references.pmid: 3335466
references.citation: Int J Eat Disord. 2004 Jul;36(1):22-30
references.pmid: 15185268
references.citation: Int J Eat Disord. 2005 Mar;37(2):175-7
references.pmid: 15732067
references.citation: Ann Clin Psychiatry. 2006 Apr-Jun;18(2):123-7
references.pmid: 16754418
references.citation: BMJ. 2004 Jun 12;328(7453):1407
references.pmid: 15175229
references.citation: Int J Eat Disord. 1993 Nov;14(3):297-304
references.pmid: 8275066
references.citation: BMJ. 2008 Jun 28;336(7659):1495-8
references.pmid: 18583681