Refeeding Hypophosphatemia in Adolescents With Anorexia Nervosa

Abstract

The rate of adolescents presenting with anorexia nervosa (AN) is increasing. Medically unstable adolescents are admitted to the hospital for nutrition restoration. A lack of global consensus on appropriate refeeding practices of malnourished patients has resulted in inconsistent refeeding practices. Refeeding hypophosphatemia (RH) is the most common complication associated with refeeding the malnourished patient. This review sought to identify the range of refeeding rates adopted globally and the implication that total energy intake and malnutrition may have on RH while refeeding adolescents with anorexia nervosa. Studies were identified by a systematic electronic search of medical databases from 1980 to September 2012. Seventeen publications were identified, including 6 chart reviews, 1 observational study, and 10 case reports, with a total of 1039 subjects. The average refeeding energy intake was 1186 kcal/d, ranging from 125–1900 kcal/d, with a mean percentage median body mass index (% mBMI) of 78%. The average incidence rate of RH was 14%. A significant correlation between malnutrition (% mBMI) and post-refeeding phosphate was identified (R 2 = 0.6, P = .01). This review highlights the disparity in refeeding rates adopted internationally in treating malnourished adolescents with anorexia nervosa. Based on this review, the severity of malnutrition seems to be a marker for the development of RH more so than total energy intake.

Incidencia de hipofosfatemia en pacientes ingresados no críticos con nutrición enteral

“…En este sentido, O'Connor y cols., en una revisión sistemática sobre hipofosfatemia de realimentación en adolescentes con anorexia nerviosa, no observaron correlación entre la tasa de realimentación (kcal/día) y la aparición de hipofosfatemia (16). La NE proporcionaba 17,7 (11,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)8) mmol de fosfato/1.000 kcal. El análisis estadístico no mostró relación entre la cantidad de fosfato administrada y los niveles de fosfato sérico.…”

Anorexia nervosa: diagnosis, risk factors and evidence‐based treatments

“…[48][49][50] Refeeding syndrome This is characterised by a variety of metabolic and clinical features, including but not limited to hypophosphatemia, cardiac arrest, and delirium. [51][52][53] Refeeding syndrome primarily develops during the first fortnight after starting refeeding. Most guidelines recommend a stepwise increase of daily intake such as 200kcal/day.…”

Abordaje nutricional de pacientes ingresados con anorexia nerviosa

“…The rate of adolescents presenting anorexia nervosa is increasing, perhaps due to the change in the diagnostic criteria (8), and patients are presenting it at an earlier age. Approximately 40% of all new cases appear in 15-19 year-old-females (5).…”

“…Moreover, some authors argue that initiating very low energy intakes can have deleterious effects on weight gain (8). Refeeding syndrome is caused by a correction of malnutrition which is too fast, but on the other hand, we also need to avoid underfeeding caused by a rate of refeeding which is too cautious (22,23).…”

“…However, current recommendations on initial energy requirements for this patients are inconsistent, with a clear lack of controlled studies, available scientific evidence and global consensus on the most effective and safe refeeding practices in hospitalized adolescents with AN (6,8,12). The most common inpatient practice, based on international guidelines such as those of the American Dietetic Association (13), is conservative and begins the refeeding process cautiously.…”