Abstract
The refeeding syndrome is common among patients with anorexia nervosa. It may be lethal and has many manifestations. We report a case series of 14 anorexic patients admitted for feeding to a single British centre. There was a high prevalence of the refeeding syndrome, with three cases requiring higher dependency unit support and one death. We present a review of the refeeding syndrome in anorectics and highlight our impression that infection among such patients may be serious and under-recognised.
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References
- Hearing, S.D., Refeeding syndrome. BMJ, 2004; 328(7445): 908-909.
- Mehanna, H., J. Moledina, and J. Travis, Refeeding syndrome: what it is, and how to prevent and treat it. British Medical Journal, 2008; 336(7659): 1495.
- Barak, N., Refeeding Syndrome (Letter in response to article by S Hearing). British Medical Journal, 2004. http://www.bmj.com/ content/328/7445/908/reply.
- Schnitker, M.A., P.E. Mattman, and T.L. Bliss, A clinical study of malnutrition in Japanese prisoners of war. Ann Intern Med, 1951; 35(1): 69-96.
- Attia, E., Anorexia Nervosa: Current Status and Future Directins. Annu. Rev. Med., 2010.
- Golden, N. and W. Meyer, Nutritional rehabilitation of anorexia nervosa. Goals and dangers. Int J Adolesc Med Health, 2004; 16(2): 131.
- Stanga, Z., et al., Nutrition in clinical practice-the refeeding syndrome: illustrative cases and guidelines for prevention and treatment. European journal of clinical nutrition, 2008; 62(6): 687-94.
- Robinson, P., MARSIPAN: Management of Really Sick Patients with Anorexia Nervosa. Royal College of Psychiatrists: College Report, 2010; 162: 1-58.
- Philip, S., Nutritional Rehabilitation: Practical Guidelines for Refeeding the Anorectic Patient. Journal of Nutrition and Metabolism, 2010. 2010.
- Stroud, M., Nutrition Support for Adults. Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. National Institute of Health and Clinical Evidence, 2006; 1-176.
- Misra, M., et al., Effects of anorexia nervosa on clinical, hematologic, biochemical, and bone density parameters in community-dwelling adolescent girls. Pediatrics, 2004; 114(6): 1574-83.
- Mitchell, J.E. and S. Crow, Medical complications of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry, 2006; 19(4): 438-43.
- Miller, K., et al., Medical findings in outpatients with anorexia nervosa. Archives of internal medicine, 2005; 165(5): 561.
- Kaysar, N., et al., Severe hypophosphataemia during binge eating in anorexia nervosa. Archives of disease in childhood, 1991; 66(1): 138.
- Winston, A. and F. Wells, Hypophosphatemia following self-treatment for anorexia nervosa. The International journal of eating disorders, 2002; 32(2): 245-248.
- Manzato, E., et al., Anorexia nervosa: from purgative behaviour to nephropathy. a case report. Cases J, 2009; 2(1): 46.
- Greenfeld, D., et al., Ipecac abuse in a sample of eating disordered outpatients. Int J Eat Disord, 1993; 13(4): 411-4.
- Caregaro, L., et al., Sodium depletion and hemoconcentration: Overlooked complications in patients with anorexia nervosa? Nutrition, 2005; 21(4): 438-445.
- Ehrlich, S., U. Querfeld, and E. Pfeiffer, Refeeding oedema. European Child & Adolescent Psychiatry, 2006; 15(4): 241-243.
- Kishibe, M., H. Sakai, and H. Iizuka, Acute Edema/Cutaneous Distention Syndrome Associated With Refeeding in a Patient With Anorexia Nervosa. Archives of dermatology, 2009.
- Birmingham, C.L. and S. Gritzner, Heart failure in anorexia nervosa: case report and review of the literature. Eat Weight Disord, 2007; 12(1): e7-10.
- Rigaud, D., et al., Body fluid retention and body weight change in anorexia nervosa patients during refeeding. Clinical Nutrition, 2010.
- Catani, M. and R. Howells, Risks and pitfalls for the management of refeeding syndrome in psychiatric patients. Psychiatric Bulletin, 2007; 31(6): 209.
- Huang, Y.L., et al., Life-threatening refeeding syndrome in a severely malnourished anorexia nervosa patient. J Formos Med Assoc, 2001; 100(5): 343-6.
- Powers, P.S., Heart failure during treatment of anorexia nervosa. Am J Psychiatry, 1982; 139(9): 1167-70.
- Kohn, M., N. Golden, and I. Shenker, Cardiac arrest and delirium: presentations of the refeeding syndrome in severely malnourished adolescents with anorexia nervosa. Journal of Adolescent Health, 1998; 22(3): 239-243.
- Ornstein, R., et al., Hypophosphatemia during nutritional rehabilitation in anorexia nervosa: implications for refeeding and monitoring. Journal of Adolescent Health, 2003; 32(1): 83-88.
- Isner, J.M., et al., Anorexia nervosa and sudden death. Ann Intern Med, 1985; 102(1): 49-52.
- Beumont, P.J. and M. Large, Hypophosphataemia, delirium and cardiac arrhythmia in anorexia nervosa. Med J Aust, 1991; 155(8): 519-22.
- Wada, S., et al., A case of anorexia nervosa with acute renal failure induced by rhabdomyolysis; possible involvement of hypophosphatemia or phosphate depletion. Internal Medicine, 1992.31(4): 478-482.
- Cariem, A., et al., Severe hypophosphataemia in anorexia nervosa. Postgraduate medical journal, 1994; 70(829): 825.
- White, A., Points: Refeeding hypophosphataemia in anorexia nervosa and alcoholism. British Medical Journal, 1987.
- Van Dissel, J.T., H.J. Gerritsen, et al. Severe hypophosphatemia in a patient with anorexia nervosa during oral feeding. Miner Electrolyte Metab, 1992; 18(6): 365-9.
- Hall, D.E., B. Kahan, et al. Delirium associated with hypophosphatemia in a patient with anorexia nervosa. J Adolesc Health, 1994; 15(2): 176-8.
- Birmingham, C., A. Alothman, and E. Goldner, Anorexia nervosa: refeeding and hypophosphatemia. International Journal of Eating Disorders, 1996; 20(2): 211-213.
- Sylvester, C.J. and S.F. Forman, Clinical practice guidelines for treating restrictive eating disorder patients during medical hospitalization. Curr Opin Pediatr, 2008; 20(4): 390-7.
- Whitelaw, M. and H. Gilbertson, Does Aggressive Refeeding in Hospitalized Adolescents With Anorexia Nervosa Result in Increased Hypophosphatemia? Journal of Adolescent Health, 2010.
- Swenne, I., Heart risk associated with weight loss in anorexia nervosa and eating disorders: electrocardiographic changes during the early phase of refeeding. Acta Paediatrica, 2000; 89(4): 447-452.
- Macias-Robles, M., et al., Prolonged QT interval in a man with anorexia nervosa. International Archives of Medicine, 2009; 2: 23.
- Sugimoto, T., et al., Central pontine myelinolysis associated with hypokalaemia in anorexia nervosa. Journal of Neurology, Neurosurgery & Psychiatry, 2003; 74(3): 353.
- Stewart, K., S. O'Malley, and N. Stanley, Electrolyte disturbances and cardiac failure with hypomagnesaemia in anorexia nervosa. British Medical Journal, 1986.
- Terlevich, A., et al., Refeeding syndrome: effective and safe treatment with Phosphates Polyfusor. Alimentary pharmacology & therapeutics, 2003; 17(10): 1325-1329.
- Fonseca, V. and C. Havard, Electrolyte disturbances and cardiac failure with hypomagnesaemia in anorexia nervosa. British Medical Journal, 1985; 291(6510): 1680.
- Birmingham, C.L., D. Puddicombe, and J. Hlynsky, Hypomagnesemia during refeeding in anorexia nervosa. Eat Weight Disord, 2004. 9(3): 236-7.
- Davidson, A., P. Anisman, and E. Eshaghpour, Heart failure secondary to hypomagnesemia in anorexia nervosa. Pediatric Cardiology, 1992; 13(4): 241-242.
- Yasuhara, D., et al., A characteristic reactive hypoglycemia induced by rapid change of eating behavior in anorexia nervosa: A case report. International Journal of Eating Disorders, 2003; 34(2): 273-277.
- Sakurai-Chin, C., et al., Hypoglycemic Coma in a Patient with Anorexia Nervosa Coincident with Acute Exacerbation of Liver Injury Induced by Oral Intake of Nutrients. Internal Medicine, 2010.
- Sakada, M., et al., Severe steatosis resulted from anorexia nervosa leading to fatal hepatic failure. J Gastroenterol, 2006; 41(7): 714-715.
- Brown, R., et al., Bacterial infections in anorexia nervosa: delayed recognition increases complications. International Journal of Eating Disorders, 2005; 37(3): 261-265.
- Shimoni, Z., A. Goldenberg, and M. Niven, Fatal invasive pulmonary aspergillosis presenting as profound hypoglycemia in a patient with anorexia nervosa. European Journal of Internal Medicine, 2006; 17(4): 295-297.
- Miller, S., Death resulting from overzealous total parenteral nutrition: the refeeding syndrome revisited. Nutrition in Clinical Practice, 2008; 23(2): 166.
- Birmingham, C., et al., Reduced febrile response to bacterial infection in anorexia nervosa patients. The International journal of eating disorders, 2003; 34(2): 269.
- Yasuhara, D., et al., Glucose tolerance predicts short-term refeeding outcome in females with anorexia nervosa. Psychosom Med, 2005; 67(4): 669-76.
- Nova, E., et al., The adaptive response of the immune system to the particular malnutrition of eating disorders. European journal of clinical nutrition, 2002; 56: S34.
- Hotta, M., et al., Two young female patients with anorexia nervosa complicated by Mycobacterium tuberculosis infection. Internal Medicine, 2004; 43(5): 440-444.
- Devuyst, O., et al., Haematological changes and infectious complications in anorexia nervosa: a case-control study. QJM, 1993; 86(12): 791.
- Vaisman, N., et al., Superoxide production during refeeding in patients with anorexia nervosa. Metabolism, 1992.
- Hütter, G., S. Ganepola, and W.-K. Hofmann, The hematology of anorexia nervosa. The International journal of eating disorders, 2009. 42(4): 293-300.
- Warrell, D.C., TM, Firth, JD, Oxford Textbook of Medicine, in Oxford Textbook of Medicine. 2003; Oxford University Press. 1060.
- Tsukamoto, M., et al., Hepatocellular injuries observed in patients with an eating disorder prior to nutritional treatment. Internal Medicine, 2008. 47(16): 1447-1450.
- Dowman, J., R. Arulraj, and I. Chesner, Recurrent acute hepatic dysfunction in severe anorexia nervosa. International Journal of Eating Disorders, 2009.
- Ozawa, Y., T. Shimizu, and Y. Shishiba, Elevation of serum aminotransferase as a sign of multiorgan-disorders in severely emaciated anorexia nervosa. Internal Medicine, 1998; 37(1): 32-39.
- Winston, A., et al., Prevalence of thiamin deficiency in anorexia nervosa. International Journal of Eating Disorders, 2000; 28(4): 451-454.
- Saad, L., et al., Anorexia nervosa and Wernicke-Korsakoff syndrome: a case report. J Med Case Reports, 2010. 4: 217.
- Peters, T., et al., A case report of wernicke's encephalopathy in a pediatric patient with anorexia nervosa-: Restricting type. Journal of Adolescent Health, 2007; 40(4): 376-383.
- Evans, D., Acute dilatation and spontaneous rupture of the stomach. The British journal of surgery, 1968.
- Jennings, K. and A. Klidjian, Acute gastric dilatation in anorexia nervosa. British Medical Journal, 1974; 2(5917): 477.
- Backett, S., Acute pancreatitis and gastric dilatation in a patient with anorexia nervosa. Postgraduate Medical Journal, 1985; 61(711): 39.
- Alloway, R., et al., Neuropathy and myopathy in two patients with anorexia and bulimia nervosa. J Neurol Neurosurg Psychiatry, 1985; 48(10): 1015-20.
- Stahl, M., et al., Prolonged acute renal failure after i.v. immunoglobulin therapy in the refeeding phase of anorexia nervosa. Nephrol Dial Transplant, 1998; 13(9): 2364-7.
- Patel, A., L. Matthews, and W. Bruce-Jones, Central pontine myelinolysis as a complication of refeeding syndrome in a patient with anorexia nervosa. Journal of Neuropsychiatry and Clinical Neurosciences, 2008. 20(3): 371.
- Haglin, L., Hypophosphataemia in anorexia nervosa. Postgraduate Medical Journal, 2001. 77(907): 305.
- Tey, H., S. Lim, and A. Snodgrass, Refeeding oedema in anorexia nervosa. Singapore medical journal, 2005; 46(6): 308.
- Cooke, R., et al., QT interval in anorexia nervosa. British heart journal, 1994; 72(1): 69.
- DiVasta, A.D., et al., Malnutrition and hemodynamic status in adolescents hospitalized for anorexia nervosa. Arch Pediatr Adolesc Med. 164(8): 706-13.
- Fabbian, F., et al., Estimation of renal function in patients with eating disorders. The International journal of eating disorders, 2010.
- Lin, Y., C. Chang, and M. Tseng, Re-Feeding-Induced Hypomania in an Anorexia Nervosa Patient With Hyperthyroidism. American Journal of Psychiatry, 2009; 166(9): 1066.
- Kinzig, K.P., et al., Insulin, glucose, and pancreatic polypeptide responses to a test meal in restricting type anorexia nervosa before and after weight restoration. Am J Physiol Endocrinol Metab, 2007; 292(5): E1441-6.
- Gentile, M., et al., Specialized refeeding treatment for anorexia nervosa patients suffering from extreme undernutrition. Clinical Nutrition, 2010.
- Vignaud, M., et al., Refeeding syndrome influences outcome of anorexia nervosa patients in intensive care unit: an observational study. Critical care (London, England), 2010; 14(5): R172.
- Rigaud, D., et al., A randomized trial on the efficacy of a 2-month tube feeding regimen in anorexia nervosa: A 1-year follow-up study. Clinical Nutrition, 2007; 26(4): 421-429.
