Safe refeeding management of anorexia nervosa inpatients: an evidence-based protocol

Hofer, Michaël; Pozzi, Antonio; Joray, Maya Lucia; Ott, Rebecca; Hähni, Florence; Leuenberger, M.; Känel, Roland von; Stanga, Zeno

doi:10.1016/j.nut.2013.09.019

Cited by 63 publications

(126 citation statements)

References 24 publications

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“…Although there is no universally accepted approach to the diagnosis and documentation of malnutrition, standardized protocols should be put in place to assess each patient's anthropometric and laboratory data, previous and current food/nutrient/fluid intake, and functional recommendations from the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition 1 . The use of a standardized approach to identify and treat malnutrition can lead to cost‐effective patient‐centered nutrition support therapy 28 Question 1.2.…”

Section: Section 1 Assessment and Recommendationsmentioning

confidence: 99%

ASPEN Safe Practices for Enteral Nutrition Therapy

Boullata

Carrera²,

Harvey

et al. 2016

J Parenter Enteral Nutr

351

531

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Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.

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Section: Section 1 Assessment and Recommendationsmentioning

confidence: 99%

ASPEN Safe Practices for Enteral Nutrition Therapy

Boullata

Carrera²,

Harvey

et al. 2016

J Parenter Enteral Nutr

351

531

View full text Add to dashboard Cite

show abstract

“…A combination of refeeding through both PPN and gradually increasing the oral balanced diet was started. As previously recommended (albeit currently under debate), the initial amount of calorie intake administered in our AN patient was as low as 10 kcal/kg/day and progressively increased to 90 kcal/kg/day without biochemical or clinical signs of refeeding syndrome (20,21). Regarding this progressive diet, current understanding holds that AN patients (particularly those with restricting type) tend to require stepwise escalation in their caloric intake to maintain a 1- to 1.5-kg/week weight gain, starting from 20-30 kcal/kg/day and increasing to 60-100 kcal/kg/day to show sustained weight gain (22).…”

Section: Discussionmentioning

confidence: 61%

Near-fatal Anorexia Nervosa in a Middle-aged Woman

et al. 2017

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Anorexia nervosa (AN) is a serious psychiatric disorder which typically occurs in young women; however, more and more cases in middle-aged women are being reported. The management of this complex disease requires a team approach, and full recovery occurs only in 50% of patients. Endocrine and metabolic complications are commonly observed, the latter of which may even be life-threatening, and require prompt and proper management. Infections, albeit reported, are not usually a major clinical problem in these patients. We herein report the case of a severely malnourished middle-aged woman with long-standing AN who was hospitalized with marked hypokalaemia (1.5 mEq/L) and rhabdomyolysis; during hospitalization she developed septic shock and acute respiratory distress syndrome, which required urgent admission to the intensive care unit. She underwent sedation and tracheal intubation for mechanical ventilation and was managed with combined therapies, which eventually led to a successful outcome. Life-threatening medical complications can occur not only in young women but in middle-aged women with AN as well and require a combined multidisciplinary approach.

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“…These results differ considerably from studies examining the prevalence of RFS using the Rio et al . diagnostic criteria, with rates of 0–2% . Studies with similar RFS prevalence rates (>50%) used decreases in serum electrolyte values to identify RFS.…”

Section: Discussionmentioning

confidence: 99%

“…have proposed that a diagnosis should only be made when there is development of a minimum of one severely low serum electrolyte, with oedema, and a severe disturbance to organ function. Using Rio et al .’s method, 0–2% of examined hospital populations have developed RFS, whereas studies that have focused solely on electrolyte imbalances have prevalence figures of up to 80% …”

Section: Introductionmentioning

confidence: 99%