Introduction. This study examines weight gain and assesses complications associated with refeeding hospitalised adolescents with restrictive eating disorders (EDs) prescribed initial calories above current recommendations. Methods. Patients admitted to an adolescent ED structured “rapid refeeding” program for >48 hours and receiving ≥2400 kcal/day were included in a 3-year retrospective chart review. Results. The mean (SD) age of the 162 adolescents was 16.7 years (0.9), admission % median BMI was 80.1% (10.2), and discharge % median BMI was 93.1% (7.0). The mean (SD) starting caloric intake was 2611.7 kcal/day (261.5) equating to 58.4 kcal/kg (10.2). Most patients (92.6%) were treated with nasogastric tube feeding. The mean (SD) length of stay was 3.6 weeks (1.9), and average weekly weight gain was 2.1 kg (0.8). No patients developed cardiac signs of RFS or delirium; complications included 4% peripheral oedema, 1% hypophosphatemia (<0.75 mmol/L), 7% hypomagnesaemia (<0.70 mmol/L), and 2% hypokalaemia (<3.2 mmol/L). Caloric prescription on admission was associated with developing oedema (95% CI 1.001 to 1.047; p = 0.039). No statistical significance was found between electrolytes and calories provided during refeeding. Conclusion. A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome.
The paper explores how both the imagining and the seeming inability to imagine their own recovery can be understood in relation to participants' self-constructions and to culturally dominant notions of personhood and eating disorders. The implications of the analysis for therapeutic interventions are discussed.
In this study 39 participants who had all been hospitalized, either in Britain or Australia, at least once for anorexia nervosa and/or bulimia, were interviewed about their experiences of treatment for an eating disorder. Each interview lasted approximately 1 hour and was semi-structured in nature covering: (i) the beginning of participants' problems and their initial diagnosis; (ii) their history of previous interventions; (iii) their current in-patient treatment episode; (iv) their views on their recovery and future. Interview was audio-tape recorded and transcribed verbatim. The resulting interview transcripts were then analysed qualitatively using a discourse analytic methodology in order to identify the ways in which participants discursively constituted their treatment experiences. More specifically, the article focuses on an analysis of how 'the eating disordered patient' was constituted in participants' accounts both as a self-construction and as a construction attributed to healthcare workers. The implications of these subject im/positions of 'the eating disordered patient' are discussed.
The contribution of nurses is a significant but notably underresearched aspect of hospital-based eating disorders treatment. This paper reports a qualitative interview-based study in which 15 nurses were interviewed about nursing children and adolescents diagnosed with eating disorder. A discourse analytic methodology was employed to analyse the resulting interview transcripts and focuses, in particular, on elucidating the various ways in which 'eating disorders nursing' was construed in participants' accounts. Three key constructions were revealed in which 'eating disorders nursing' was discursively constituted (i) as 'loving' or empathetic support, (ii) as a surveillance and disciplining of patients and (iii) as a constant and ever-present care. The implications of these constructions are discussed.
Avoidant/restrictive food intake disorder (ARFID) is a potentially lethal eating disorder. This case example of a male, G, aged 17 years with ARFID illustrates the multiplicity of health problems related to nutritional deficiencies which may develop in an adolescent of normal weight. Of particular concern was the diagnosis of subacute combined degeneration (SCD) of the spinal cord and the real possibility that G may have irreversible damage to his spinal cord. To our knowledge, this is the first reported case of a patient with SCD of the spinal cord due to ARFID. The adolescent was found to be deficient in Vitamin A, E, K, D, B12, and folate. Management required vitamin replacement, initial nasogastric feeding and the slow introduction of a varied diet. This patient will require long term rehabilitation. Medical practitioners need to be attuned to abnormal eating patterns in children and adolescents and refer for specialist care early.
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