A case report: Treatment of severe anorexia nervosa with home total parenteral hyperalimentation

Abstract

Abstract:In its chronic and severe phase, anorexia nervosa (AN) carries a high morbidity and mortality rate. In the severe stage, parenteral alimentation is often required. To date, the optimal regime for parenteral refeeding has not been well documented. Most, if not all, such treatment is performed on an inpatient basis. Method: We report here a case of an AN patient treated at home with total parenteral hyperalimentation which is, to the best of our knowledge, the first to be carried out in Israel. Results: The patient has regained 10 kg during treatment, and has maintained her weight a year after treatment. Her gastrointestinal symptoms improved, and she has reduced the amount of laxatives she ingests. Discussion: In this paper we will discuss the various issues and criteria applicable to this treatment, as well as the importance of collaboration between a primary care and specialized clinic.

Weight changes during inpatient refeeding of underweight eating disorder patients

“…The American Psychiatric Association (APA) guidelines recommend 0.9–1.4 kg/week with ‘ expected rates of controlled weight gain ’ (Yager et al, 2006), however there are only a few descriptions of actual weight gain in inpatient treatment. The literature is comprised of descriptions of practice based on clinical treatment in particular facilities (Okamoto et al, 2002; Zuercher, Cumella, Woods, Eberly, & Carr, 2003); case studies (Latzer, Eysen‐Eylat, & Tabenkin, 2000; Mehler & Weiner, 2007; Neiderman, Zarody, Tattersall, & Lask, 2000) or studies with small sample sizes (Arii, Yamashita, Kinoshita, Shimizu, Nakamura, & Nakajima, 1996; Silber, Robb, Orrell‐Valente, Ellis, Valadez‐Meltzer, & Dadson, 2004) and there are only a few descriptions of patterns of weight change in Anorexia Nervosa (AN) subjects with a sample size greater than 100 (Beumont, Al‐Alami, & Touyz, 1988; Diamanti et al, 2008; Zuercher et al, 2003). Evidence of how achievable described weight targets are in clinical settings is unclear as there is frequently limited detail to aid in translation of treatment practices into other settings (Davies & Jaffa, 2005).…”

Home Parenteral Nutrition Therapy in Seven Patients with Anorexia Nervosa: The Role and Indications

“…Because most patients with AN have strong phobias of weight gain, the treatment of these patients using TPN may be dangerous, even if performed in a hospital (4). The risk would be greater in a home where constant medical supervision is absent (7). Therefore, the use of HPN for patients with AN should be strictly controlled based on specific criteria.…”

“…In Western countries, HPN has been used for patients with AN since the 1980s (5). It is difficult to determine whether patients with AN can successfully use HPN, as there are only a few reports on HPN in patients with AN, and the role and indications for HPN therapy in such studies are mostly not discussed (6,7).…”