Complications and mortality in Anorexia nervosa in-patients during guideline-supported refeeding: An observational study

Introduction: Anorexia nervosa (AN) is associated with serious complications related to protein-energy malnutrition, pathological weight loss and low levels of micronutrients. The refeeding phase in AN patients bears a further high risk of life-threatening and potentially fatal complications. Clinical guidelines, such as the ones used here, target optimal treatment during this vulnerable time in order to reduce the chance of developing a Refeeding Syndrom (RFS).

Objectives: Goal of this study was to evaluate, if implementing evidence-based refeeding guidelines has beneficial effects on complications and mortality in a AN sample during the refeeding-phase and during hospital stay.

Methods: This is a retrospective, observational data analysis of an adult AN sample fulfilling the DSM-IV-TR diagnostic criteria. All patients hospitalized during a 5-year period (2007 – 2011) in the Division of Psychosomatic Medicine were enrolled.

Results: Due to high compliance to our guidelines, none of the AN 65 patients (86 cases) did develop a RFS. While some of the patients developed AN typical complications as well as complications, which are related to RFS, none developed a RFS based on the definition by Rio et al (2013), which includes severe electrolyte imbalances and disturbance in the organ function in addition to peripheral oedema.

Conclusion: Due to the adherence to guidelines with prior substitution of electrolytes, only few patients showed mild dyselectrolytemia like low levels of potassium, magnesium or anorganic phosphate during the refeeding phase, which was gradually being restored to normal levels. Compared to the literature we registered considerable lower refeeding related complications (14%). Gaudiani et al. (2012) described a RFS prevalence of 28%, Derman et al. (2009) even more than 50%.

Disclosure of Interest: None Declared