title: Metabolic and nutritional needs to normalize body mass index by doubling the admission body weight in severe anorexia nervosa.
abstract: Anorexia nervosa exhibits one of the highest death rates among psychiatric patients and a relevant fraction of it is derived from undernutrition. Nutritional and medical treatment of extreme undernutrition present two very complex and conflicting tasks: (1) to avoid "refeeding syndrome" caused by a too fast correction of malnutrition; and (2) to avoid "underfeeding" caused by a too cautious refeeding. To obtain optimal treatment results, the caloric intake should be planned starting with indirect calorimetry measurements and electrolyte abnormalities accurately controlled and treated. This article reports the case of an anorexia nervosa young female affected by extreme undernutrition (BMI 9.6 kg/m(2)) who doubled her admission body weight (from 22.5 kg to 44 kg) in a reasonable time with the use of enteral tube feeding for gradual correction of undernutrition. Refeeding syndrome was avoided through a specialized and flexible program according to clinical, laboratory, and physiological findings.
authors: Eating Disorders Unit, Niguarda Hospital, Milan Italy.
authors: Maria Gabriella
authors: MG
authors: Gentile
authors: Chiara
authors: C
authors: Lessa
authors: Marina
authors: M
authors: Cattaneo
keywords: anorexia nervosa; extreme undernutrition; hypophosphatemia; refeeding syndrome
references: Int J Eat Disord. 2005;37 Suppl:S52-9; discussion S87-9
references: 15852321
references: Eur J Clin Nutr. 1990 Apr;44(4):329-35
references: 2364921
references: Oral Oncol. 2011 Sep;47(9):792-6
references: 21733741
references: Clin Nutr. 2012 Jun;31(3):429; author reply 430
references: 22154934
references: J Adolesc Health. 1998 Mar;22(3):239-43
references: 9502012
references: Nutrients. 2012 Sep;4(9):1293-303
references: 23112917
references: Clin Nutr. 2010 Oct;29(5):627-32
references: 20416994
references: Ann Clin Psychiatry. 2006 Apr-Jun;18(2):123-7
references: 16754418
references: BMJ. 2008 Jun 28;336(7659):1495-8
references: 18583681
references: Curr Opin Clin Nutr Metab Care. 2011 Mar;14(2):186-92
references: 21102317
references: Am J Clin Nutr. 2004 Dec;80(6):1469-77
references: 15585757
references: Eur J Clin Nutr. 2008 Jun;62(6):687-94
references: 17700652
references: J Biol Chem. 2012 May 25;287(22):17942-50
references: 22474325
references: J Nutr Metab. 2010;2010:
references: 20798756
references: Clin Nutr. 2008 Feb;27(1):5-15
references: 18061312
references: Nutr Clin Pract. 2008 Apr-May;23(2):166-71
references: 18390784
references: Eur J Gastroenterol Hepatol. 2000 Feb;12(2):191-6
references: 10741934
references: Int J Eat Disord. 2012 Apr;45(3):439-42
references: 22009708
references: Nutrition. 2001 May;17(5):422-3
references: 11377140
references: J Intensive Care Med. 2005 May-Jun;20(3):155-9
references: 15888903
references: Acute Med. 2011;10(2):69-76
references: 22041604
references: Neuropediatrics. 2012 Jun;43(3):152-4
references: 22473289
references: Am J Psychiatry. 2000 Jan;157(1 Suppl):1-39
references: 10642782
references: Crit Care. 2010;14(5):R172
references: 20920160
references: Int J Eat Disord. 2011 Dec;44(8):756-9
references: 22072414
references: BMJ. 2004 Apr 17;328(7445):908-9
references: 15087326
references: Int J Eat Disord. 2012 Jan;45(1):85-92
references: 22170021
references: Eur Eat Disord Rev. 2012 Mar;20(2):94-105
references: 22052722
references: Int J Eat Disord. 2010 Dec;43(8):766-9
references: 19950117
references: J Adolesc Health. 2012 Jan;50(1):24-9
references: 22188830