Safe refeeding management of anorexia nervosa inpatients: an evidence-based protocol.
OBJECTIVE
Anorexia nervosa is associated with several serious medical complications related to malnutrition, severe weight loss, and low levels of micronutrients. The refeeding phase of these high-risk patients bears a further threat to health and potentially fatal complications. The objective of this study was to examine complications due to refeeding of patients with anorexia nervosa, as well as their mortality rate after the implementation of guidelines from the European Society of Clinical Nutrition and Metabolism.


METHODS
We analyzed retrospective, observational data of a consecutive, unselected anorexia nervosa cohort during a 5-y period. The sample consisted of 65 inpatients, 14 were admitted more than once within the study period, resulting in 86 analyzed cases.


RESULTS
Minor complications associated with refeeding during the first 10 d (replenishing phase) were recorded in nine cases (10.5%), four with transient pretibial edemas and three with organ dysfunction. In two cases, a severe hypokalemia occurred. During the observational phase of 30 d, 16 minor complications occurred in 14 cases (16.3%). Six infectious and 10 non-infectious complications occurred. None of the patients with anorexia nervosa died within a follow-up period of 3 mo.


CONCLUSIONS
Our data demonstrate that the seriousness and rate of complications during the replenishment phase in this high-risk population can be kept to a minimum. The findings indicate that evidence-based refeeding regimens, such as our guidelines are able to reduce complications and prevent mortality. Despite anorexia nervosa, our sample were affected by serious comorbidities, no case met the full diagnostic criteria for refeeding syndrome.
Department of General Internal Medicine, Bern University Hospital, and University of Bern, Switzerland.
Michael
M
Hofer
Department of General Internal Medicine, Bern University Hospital, and University of Bern, Switzerland.
Antonio
A
Pozzi
Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital, and University of Bern, Switzerland.
Maya
M
Joray
Department of General Internal Medicine, Bern University Hospital, and University of Bern, Switzerland; Division of Psychosomatic Medicine, Bern University Hospital, and University of Bern, Switzerland.
Rebecca
R
Ott
Division of Psychosomatic Medicine, Bern University Hospital, and University of Bern, Switzerland.
Florence
F
Hähni
Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital, and University of Bern, Switzerland.
Michéle
M
Leuenberger
Department of General Internal Medicine, Bern University Hospital, and University of Bern, Switzerland; Division of Psychosomatic Medicine, Bern University Hospital, and University of Bern, Switzerland; Department of Clinical Research, University of Bern, Switzerland.
Roland
R
von Känel
Department of General Internal Medicine, Bern University Hospital, and University of Bern, Switzerland; Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital, and University of Bern, Switzerland. Electronic address: Zeno.stanga@insel.ch.
Zeno
Z
Stanga
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000150:complications / Q000401:mortality / Q000628:therapy*; D002985:Clinical Protocols; D004487:Edema / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007008:Hypokalemia / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D008297:Male; D044623:Nutrition Therapy; D017410:Practice Guidelines as Topic; D055677:Refeeding Syndrome / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
Anorexia nervosa; Complications; Mortality; Refeeding; Refeeding syndrome