Hypophosphatemia secondary to oral refeeding in anorexia nervosa

Fisher, Martin; Simpser, Edwin; Schneider, Marcie

doi:10.1002/1098-108x(200009)28:2<181::aid-eat7>3.0.co;2-k

Cited by 103 publications

(42 citation statements)

References 11 publications

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“…This scenario of sub-optimal intake of calories tends to be inadvertently protective against the effects of the re-feeding syndrome. Therefore, in most instances, refeeding syndrome is treated by cautious progressive nutrition achieved by a reduction in volume and caloric density of the feeds (l0, 14,19,20).…”

Section: Discussionmentioning

confidence: 99%

Hypo-phosphataemia in children under five years with kwashiorkor and marasmic kwashiorkor

Kimutai¹,

Maleche‐Obimbo²,

Kamenwa³

et al. 2010

E Af Med Jrnl

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Background: Severe malnutrition contributes up to 50% of childhood mortality in developing countries is frequently characterised by electrolyte depletion, including low total body phosphate. During therapeutic re-feeding, electrolyte shift from extracellular to intra-cellular compartments may induce hypo-phosphataemia (hypo-P) with resultant increased morbidity and mortality. This biochemical imbalance is under-recognised, and the frequency of this problem among African malnourished children is unclear. Objectives: To determine the magnitude of hypo-phosphataemia in children under five years of age presenting to Kenyatta National Hospital with kwashiorkor and marasmic kwashiorkor and to evaluate the relationship between hypo-phosphataemia and nutritional intervention during the first five days of treatment. Design: Short longitudinal survey. Setting: The General Paediatric wards of the Kenyatta National Hospital (KNH), Nairobi. Subjects: Children under five years of age presenting with kwashiorkor or marasmic kwashiorkor at KNH were recruited into the study. Main outcome measures: Low serum phosphate level (<1.20mmol/l) and patient outcome (survival or death) during the first five days of treatment. Results: One hundred and sixty five children were enrolled between June 2005 and February 2006 of which 107 (64%) had kwashiorkor and 58 (36%) had marasmic kwashiorkor. They were of mean age 20 months (range 3-60), and 95 (58%) were male. The prevalence of hypo-phosphataemia was 86% on admission, increased to 90% and 93% on day one and two respectively, and then declined to 90% by the fourth day. At admission 6% were hypo-phosphataemic, increasing to 18% and 22% on day one and two respectively, and declining to 11% by day four. On admission mean serum phosphate was below normal at 0.91mmol/l, declined significantly to 0.67mmol/l and to a nadir of 0.63mmol/l after the first and second day of treatment respectively, then rose slightly to 0.75mmol/l on the fourth day (p<0.001 comparing each follow-up mean level with the admission level). There was a positive association between severity of nadir serum phosphate level and mortality (p=0.028). There were no deaths among children with normal nadir serum phosphate levels. However, among children with mild, moderate and severe nadir hypo-phosphataemia, 8, 14 and 21% died respectively. Children with dermatosis and hypomagnesaemia showed a trend for association with mortality (p=0.082 and 0.099 respectively). Conclusion: Hypo-phosphataemia is frequent among children with kwashiorkor and marasmic kwashiorkor presenting at KNH. Serum phosphate levels decline significantly during the first two days of nutritional intervention, and severity of hypo-phosphataemia is directly associated with mortality.

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Section: Discussionmentioning

confidence: 99%

Hypo-phosphataemia in children under five years with kwashiorkor and marasmic kwashiorkor

Kimutai¹,

Maleche‐Obimbo²,

Kamenwa³

et al. 2010

E Af Med Jrnl

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“…Three-fourths of these adolescents reached a phosphorus nadir within the first week of hospitalization. 24 In Fisher et al, 25 severely malnourished young people with AN developed significant hypophosphatemia along with other clinical features of the refeeding syndrome with oral feeds. That report emphasized the need for hospitalization with close medical monitoring and slow oral refeeding.…”

Section: Refeeding Syndromementioning

confidence: 99%

Medical complications in adolescents with anorexia nervosa: A review of the literature

Katzman

2005

Int. J. Eat. Disord.

324

209

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“…Cautious refeeding, careful monitoring of serum electrolyte, magnesium, phosphorus, and glucose levels, and a low threshold for phosphorus supplementation prevent the development of refeeding syndrome. 71,72,[120][121][122][123] Refeeding syndrome is unusual after the first 2 weeks of nutritional rehabilitation or in patients being treated in the outpatient setting.…”

Section: Hospital-based Treatmentmentioning

confidence: 99%

Identification and Management of Eating Disorders in Children and Adolescents

Rosen¹

2010

Pediatrics

300

171

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The incidence and prevalence of eating disorders in children and adolescents has increased significantly in recent decades, making it essential for pediatricians to consider these disorders in appropriate clinical settings, to evaluate patients suspected of having these disorders, and to manage (or refer) patients in whom eating disorders are diagnosed. This clinical report includes a discussion of diagnostic criteria and outlines the initial evaluation of the patient with disordered eating. Medical complications of eating disorders may affect any organ system, and careful monitoring for these complications is required. The range of treatment options, including pharmacotherapy, is described in this report. Pediatricians are encouraged to advocate for legislation and policies that ensure appropriate services for patients with eating disorders, including medical care, nutritional intervention, mental health treatment, and care coordination.

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Hypophosphatemia secondary to oral refeeding in anorexia nervosa

Cited by 103 publications

References 11 publications

Hypo-phosphataemia in children under five years with kwashiorkor and marasmic kwashiorkor

Hypo-phosphataemia in children under five years with kwashiorkor and marasmic kwashiorkor

Medical complications in adolescents with anorexia nervosa: A review of the literature

Identification and Management of Eating Disorders in Children and Adolescents

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