Life-threatening refeeding syndrome in a severely malnourished anorexia nervosa patient
Journal
Journal of the Formosan Medical Association
Journal Volume
100
Journal Issue
5
Pages
343-346
Date Issued
2001
Author(s)
Abstract
Overzealous refeeding in chronically malnourished anorexia nervosa patients may cause life-threatening complications. We describe a 14-year-old girl with anorexia nervosa who had a decrease in body weight from 45 kg to 25.5 kg over an 18-month period. She received 40 kcal·kg-1·d-1 carbohydrate-rich nutrition via enteral and parenteral routes. Her serum phosphate concentration dropped from a baseline of 1.39 mmol/L (4.3 mg/dL) to 0.19 mmol/L (0.6 mg/dL) on Day 4 of refeeding. Concurrent with the development of hypophosphatemia, she became drowsy and developed generalized muscle weakness, impaired myocardial contractility, thrombocytopenia, and gastrointestinal bleeding. Fluid overload with pulmonary edema complicated her recovery from these adverse events. After intravenous phosphate supplementation and fluid restriction, the symptoms of refeeding syndrome gradually resolved within 2 weeks. In chronically malnourished anorexia nervosa patients, nutritional support should be instituted gradually to avoid rapid electrolyte shifts and fluid overload. Serum phosphate concentrations, fluid status, and blood cell counts should be closely monitored.
SDGs
Other Subjects
carbohydrate; furosemide; phosphate; adolescent; anorexia nervosa; article; blood cell count; body fluid; carbohydrate diet; case report; chronic disease; complication; concentration (parameters); diet supplementation; disease severity; drowsiness; enteric feeding; female; gastrointestinal hemorrhage; heart muscle contractility; human; hypervolemia; hypophosphatemia; lung edema; malnutrition; mental patient; muscle weakness; nutritional support; parenteral nutrition; phosphate blood level; refeeding; symptom; syndrome; thrombocytopenia; time; weight reduction; Adolescent; Anorexia Nervosa; Feeding Methods; Female; Food, Formulated; Humans; Hypophosphatemia; Pulmonary Edema; Syndrome
Type
journal article