Outcomes of a rapid refeeding protocol in Adolescent Anorexia Nervosa

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• 作者：Sloane Madden ; Jane Miskovic-Wheatley ; Simon Clarke…
• 关键词：Anorexia Nervosa ; Eating disorder ; Inpatient treatment ; Refeeding syndrome ; Adolescents ; Nasogastric refeeding ; Rapid refeeding
• 刊名：Journal of Eating Disorders
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：3
• 期：1
• 全文大小：868 KB
• 参考文献：Treatment of patients with eating disorders (3rd ed.). Am J Psychiat 163: pp. 4-54
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• 刊物主题：Health Promotion and Disease Prevention; Public Health;
• 出版者：BioMed Central
• ISSN：2050-2974

文摘

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 (12-8 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 24-2 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 2400-000?kcal/day. Along with indicators of medical stability, weight, phosphate and glucose levels were recorded. Results All patients gained weight in week one (M--.79?kg, SD--.27?kg) and at subsequent measurement points with an average gain of 5.12?kg (SD--.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. Trial registration Australian Clinical Trials Register number: ACTRN012607000009415