Treatment with intravenous hyperalimentation for severely anorectic patients and its outcome

Abstract

In treating patients with severe anorexia nervosa, it is important to improve their physical condition first. Patients who had lost close to 60% standard bodyweight (SBW) were candidates for inpatient treatment due to the mortality risk. With 80% SBW as the target for therapy, they were given both intravenous hyperalimentation and food by oral intake in order to improve their physical condition. In total, 51 patients were admitted. One died and four patients dropped out in the course of treatment. Forty-six patients who completed the inpatient treatment were reviewed. Although admitted with an average weight of approximately 60% SBW, they were discharged with a weight of approximately 80% SBW after approximately 60 days. An average follow up of 25.0 months was conducted, and two patients were found to have died. The mean weight, percentage resuming menstruation, and rehospitalization rate of the 44 survivors were 79% SBW, 23%, and 32%, respectively. The patients with the restricting type of anorexia had an earlier onset of the disorder and a better social outcome. Patients in whom onset occurred at a younger age had a better social outcome. After being discharged, the majority of the patients continued treatment as outpatients. Although the results were similar to those of conventional studies in terms of outcome, the shorter hospitalization was significant. Overall, in the treatment of patients with severe anorexia nervosa, it is important to begin psychotherapy while trying to improve their physical condition.

Clinical Efficacy and Safety of Parenteral Nutrition in Adolescent Girls with Anorexia Nervosa

“…This study found good short-term nutritional outcomes of PN, but after a much longer hospital stay than in our experience. In our series the length of hospital stay was longer in PN-treated patients than in patients treated only by oral means, but was shorter than in two previous studies reporting patients with similar degrees of malnutrition [5,11]. Research that addresses the optimal length of hospitalization is scarce in this field.…”

“…Also the comparison with these studies is not easy, because the first [11] referred to adult patients and the second [4] to adolescents who were less malnourished than those reported in our study. Tonoike et al [5], on the contrary, report their experience in 51 adult patients treated by PN, without a control group. This study found good short-term nutritional outcomes of PN, but after a much longer hospital stay than in our experience.…”

“…However, because forced PN or EN refeeding can be accompanied by important dangers, these interventions should be used in selected cases [4]. There are few studies published in this regard [5][6][7], and some reports refer to adult patients [5,7]. Adulthood differs from adolescence because of the developmental process, which has to be taken into consideration in determining the diagnosis, treatment, and outcome of eating disorders [3].…”

“…Enteral nutrition (EN) and parenteral nutrition (PN) are both used in nutritional rehabilitation of AN patients [2][3][4][5][6][7]. EN showed beneficial effects in improving nutritional status of AN patients [6 -8].…”

Enteral Nutrition as a Life-Saving Treatment in Patients with Severe Anorexia Nervosa

“…Criteria for life-saving intervention with artificial nutrition in anorexia nervosa patients Although it has always been stressed how crucial nutritional rehabilitation is in these patients, where only few studies are reporting the use of artificial nutrition in anorexia nervosa patients. Enteral nutrition and parenteral nutrition are both used in nutritional rehabilitation of severe anorexia nervosa patients (Paccagnella et al, 2006;Robb et al, 2002;Tonoike et al, 2004;Zuercher et al, 2003;Gentile et al, 2008;Gentile et al, 2010).…”