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An audit of a high caloric refeeding regimen used for medically unstable adolescent inpatients with severe restrictive eating disorders

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Aim

To present data on outcomes including weight and BMI gain, length of stay and complications of a high caloric refeeding regimen.

Methods

A retrospective audit of 98 consecutive admissions over 36 months of medically unstable patients (Defined as bradycardic HR ≤50), who had a BMI of ≤18.5 kg/m2. Patients were prescribed a regimen of nasogastric feeds and oral diet graded up from 2400 Kcal/day to over 4000 Kcal/day. Prophylactic oral phosphate was routinely prescribed.

Results

Median age 16.6 years (range: 14.7 - 19.9), median BMI 16.2 kg/m2 (12.4 - 18.5) on admission. Median weight gain in first week 4.0 kg (1.2 – 6.9), median total weight gain 7.8 kg (3.3 - 18.3). Median BMI on discharge 19.1 kg/m2 (16.4 - 21.0). Median length of stay 24.4 days (6.0 – 82.3 days). No admissions resulted in refeeding syndrome. Peripheral oedema and/or mild electrolyte abnormality occurred in 20.4% of admissions.

Conclusion

It is possible to use a refeeding regimen that is higher in total caloric intake than currently recommended approaches, including NICE guidelines. With specialist medical and nursing care, relatively rapid weight gain and clinical stabilisation occurs with minimal complications. A prospective comparison between centres or a randomised controlled trial would contribute further to the evidence in this field.

This abstract was presented in the Service Initiatives: Child and Adolescent Refeeding and FBT stream of the 2014 ANZAED Conference.

Author information

Correspondence to Danielle Hewitt.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Hewitt, D., Anderson, G., Kennedy, A. et al. An audit of a high caloric refeeding regimen used for medically unstable adolescent inpatients with severe restrictive eating disorders. J Eat Disord 2, O20 (2014) doi:10.1186/2050-2974-2-S1-O20

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Keywords

  • Eating Disorder
  • Electrolyte Abnormality
  • Clinical Stabilisation
  • Total Caloric Intake
  • Oral Diet