There are a range of different services for treating adolescent eating disorders (ED) but there is no clinical consensus and a paucity of research indicating which type of treatment setting is the best. Although it would be ideal to have a specialized ward for these patients what happens when this is not possible? The aim of this study was to evaluate patients with ED hospitalized on a general pediatric ward. A retrospective chart review for 37 patients hospitalized for an ED and followed by a team consisting of an adolescent medicine specialist, a child and adolescent psychiatrist and a dietician on a pediatric ward were re-evaluated. Twenty-four (64.9%) patients were diagnosed with anorexia nervosa (AN) restricting type, 8 (21.6%) with anorexia nervosa binging purging type, 3 (8.1%) with bulimia nervosa (BN) and 2 (5.4%) with eating disorder otherwise not specified. The mean age at admission was 14.79 ± 1.75 years and 7 (20%) were males. A majority were hospitalized due to medical instability. Mean period of time from admittance to medical stabilization was 6.04 ± 4.79 days. The mean period of admittance was 26.4 ± 11.9 days for AN and 23.7 ± 15.03 days for BN patients. The mean calorie intake of the AN group was 607 ± 333 kcal and 2,358 ± 605 kcal at hospitalization and discharge, respectively. Hypophosphatemia occurred in 2 patients during refeeding. Mean total weight gained during the whole hospitalization period was 3,950 ± 3,524grs. This study shows that although not ideal, EDs can successfully be followed on general pediatric wards and could have implications at centers with no specialized wards.
Background Adolescents with type 1 diabetes mellitus (T1DM) are at an increased risk of eating disturbances. The aim of this study was to evaluate whether the risk of a disordered eating behavior (DEB) also applies to the well sibling sharing the same environment. Methods Well siblings were included if they were 10-18 years old, had a sibling with a T1DM diagnosis for at least 6 months and lived with the sibling during the illness. The control group was comprised of healthy participants recruited from the outpatient clinic with no family history of T1DM. Participants completed a four-part questionnaire concerning their eating behaviors that was developed by the study team. This survey aimed to evaluate the dietary habits and eating patterns. All participants completed the Eating Attitudes Test-26 (EAT-26) and a 24-h food dietary recall. Any participant with a high EAT-26 score or that seemed to be at risk according to the questionnaire was re-evaluated. Results Eight cases (33.3%) in the well sibling group had either a total and/or subgroup pathological score. Three of them were found to have DEB and one case was diagnosed with anorexia nervosa (AN). In the control group, five cases (17.2%) had either a total and/or subgroup pathological score. Three of these cases were found to have DEB, no cases were diagnosed with an eating disorder. There were no statistically significant differences in the EAT-26 scores between the groups. Conclusions Although a direct relationship was not observed, the probability of having a pathologic EAT-26 score was higher in the group with a sibling with T1DM.
Background and aimsThe refeeding syndrome (RFS) is a potentially fatal condition characterised by fluid and electrolyte abnormalities, most notably hypophosphatemia. The purpose of this study was to determine the incidence of hypophosphatemia without prophylactic phosphate supplementation during refeeding in hospitalised adolescents with Anorexia Nervosa (AN).MethodsThis study took place at the Division of Adolescent Medicine, Hacettepe University. Between January 2010 and April 2016, 32 adolescents with AN met criteria for admission. Nutritional rehabilitation was started and initial calories served depended on the type of AN (restrictive or binging-purging), the patient’s diet history and calorie intake before hospitalisation. If the patient was consuming calories less than 750kkcal/day, then 750kkcal divided into 3 meals was started. If the patient was consuming greater than 750kkcal, then 250kkcal was added to the consumption and depending on the calories divided into 3 main meals and 1–3 snacks. The daily calories were increased slowly according to weight gain. A weight gain criterion of maximum 1.0 kg/week was accepted safe to avoid RFS. Patients were followed closely and electrolytes were obtained daily for the first 5 days and longer if necessary.ResultsThe mean calorie consumed before admission was 693±557(min-max:0–3000) kkal. Mean calorie prescribed at admittance was 974±333 min-max:750–1750) kkal. Hypophosphatemia occurred in 2 patients during refeeding. The initial phosphate level was 3.74 mg/dl and 3.16 mg/dl and dropped to 2.5 mg/dl on day 2 with 1000kcal/day and 1.96 mg/dl on day 3 with 1250kcal, respectively. Replacement with oral neutral phosphate was given at 2 cc/kg for 3 days for both. There were no adverse events or clinical symptoms requiring any extra medical intervention.ConclusionsThe debate concerning prophylactic phosphate to prevent RFS continues. While some authors advise daily phosphate supplementation to all patients during initial hospitalisation period, others recommend close early monitoring and supplementation only when phosphate levels begin to decline. Authors of protocols that opt to treat prophylactically have still closely monitor their patients for the first week which means patients will still have blood drawn daily.In this study, the incidence of hypophosphatemia was found low without any phosphate supplementation. By monitoring phosphorus and supplementing as needed, we were able to avert the clinical manifestations of the RFS.
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