title: Outcomes of a rapid refeeding protocol in Adolescent Anorexia Nervosa.
abstract: BACKGROUND
  The impact of severe malnutrition and medical instability in adolescent Anorexia Nervosa (AN) on immediate health and long-term development underscores the need for safe and efficient methods of refeeding. Current refeeding guidelines in AN advocate low initial caloric intake with slow increases in energy intake to avoid refeeding syndrome. This study demonstrates the potential for more rapid refeeding to promote initial weight recovery and correct medical instability in adolescent AN.
  
  
  METHODS
  Seventy-eight adolescents with AN (12-18 years), hospitalised in two specialist paediatric eating disorder units, for medical instability (bradycardia, hypotension, hypothermia, orthostatic instability and/or cardiac arrhythmia) were followed during a 2.5 week admission. Patients were refed using a standardised protocol commencing with 24-72 hours of continuous nasogastric feeds (ceased with daytime medical stability) and routine oral phosphate supplementation, followed by nocturnal feeds and a meal plan of 1200-2400 kcal/day aiming for a total caloric intake of 2400-3000 kcal/day. Along with indicators of medical stability, weight, phosphate and glucose levels were recorded.
  
  
  RESULTS
  All patients gained weight in week one (M = 2.79 kg, SD = 1.27 kg) and at subsequent measurement points with an average gain of 5.12 kg (SD = 2.96) at 2.5 weeks. No patient developed hypophosphatemia, hypoglycaemia, or stigmata of the refeeding syndrome.
  
  
  CONCLUSIONS
  The refeeding protocol resulted in immediate weight gain and was well tolerated with no indicators of refeeding syndrome. There were no significant differences in outcomes between the treatment sites, suggesting the protocol is replicable.
  
  
  BACKGROUND
  Australian Clinical Trials Register number: ACTRN012607000009415.
authors.affiliation: Eating Disorder Service, The Sydney Children's Hospitals Network, Westmead Campus, Locked Bag 4001, Westmead, 2145, NSW Australia ; Discipline of Psychiatry, Faculty of Medicine, The University of Sydney, Sydney, Australia ; Westmead Clinical School, The Sydney Children's Hospitals Network, Westmead Campus, Sydney, Australia.
authors.forename: Sloane
authors.initials: S
authors.lastname: Madden
authors.affiliation: Eating Disorder Service, The Sydney Children's Hospitals Network, Westmead Campus, Locked Bag 4001, Westmead, 2145, NSW Australia ; Westmead Clinical School, The Sydney Children's Hospitals Network, Westmead Campus, Sydney, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Miskovic-Wheatley
authors.affiliation: Discipline of Paediatrics, Faculty of Medicine, University of Sydney, Sydney, Australia ; Centre for Research into AdolescentS' Health (CRASH), University of Sydney, Sydney, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Clarke
authors.affiliation: Clinical Psychology Unit, University of Sydney, Sydney, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Touyz
authors.affiliation: School of Medicine, University of Western Sydney, Sydney, Australia.
authors.forename: Phillipa
authors.initials: P
authors.lastname: Hay
authors.affiliation: Eating Disorder Service, The Sydney Children's Hospitals Network, Westmead Campus, Locked Bag 4001, Westmead, 2145, NSW Australia ; Westmead Clinical School, The Sydney Children's Hospitals Network, Westmead Campus, Sydney, Australia ; Discipline of Paediatrics, Faculty of Medicine, University of Sydney, Sydney, Australia ; Centre for Research into AdolescentS' Health (CRASH), University of Sydney, Sydney, Australia.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kohn
keywords: Adolescents; Anorexia Nervosa; Eating disorder; Inpatient treatment; Nasogastric refeeding; Rapid refeeding; Refeeding syndrome
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