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Open AccessArticle

Outcomes of an Accelerated Inpatient Refeeding Protocol in 103 Extremely Underweight Adults with Anorexia Nervosa at a Specialized Clinic in Prien, Germany

1
Schön Clinic Roseneck; Am Roseneck 6, 83209 Prien am Chiemsee, Germany
2
Clinic for Psychiatry, Psychosomatics and Psychotherapy of childhood and adolescence, Charité – University Berlin, corporate member of Free University Berlin, Humboldt-University Berlin, and Berlin Institute of Health, 13353 Berlin, Germany
3
Department of Psychiatry and Molecular medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
4
Department of Psychiatry, the Zucker Hillside Hospital, Glen Oaks, NY 11004, USA
5
Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München (LMU), 80336 München, Germany
6
Research program for the evaluation of psychotherapy in complex therapeutic settings, PMU Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(5), 1535; https://doi.org/10.3390/jcm9051535
Received: 17 March 2020 / Revised: 28 April 2020 / Accepted: 13 May 2020 / Published: 19 May 2020
(This article belongs to the Special Issue Advances in Eating Disorders)
Background: In mildly to moderately malnourished adolescent patients with anorexia nervosa (AN), accelerated refeeding protocols using higher initial calory supply coupled with phosphate supplements were not associated with a higher incidence of refeeding syndrome (RS). It is unclear whether this is also a feasible approach for extremely malnourished, adult AN patients. Methods: Outcomes of a clinical refeeding protocol involving a targeted initial intake of ≥2000 kcal/day, routine supplementation of phosphate and thiamine as well as close medical monitoring, were evaluated. A retrospective chart review including AN patients with a body mass index (BMI) <13 kg/m² was conducted, to describe changes in weight, BMI, and laboratory parameters (phosphate, creatine kinase, hematocrit, sodium, liver enzymes, and blood count) over four weeks. Results: In 103 female patients (age, mean ± standard deviation (SD) = 23.8 ± 5.3 years), BMI between admission and follow-up increased from 11.5 ± 0.9 to 13.1 ± 1.1 kg/m² and total weight gain within the first four weeks was 4.2 ± 2.0 kg (mean, SD). Laboratory parameter monitoring indicated no case of RS, but continuous normalization of blood parameters. Conclusions: Combined with close medical monitoring and electrolyte supplementation, accelerated refeeding may also be applied to achieve medical stabilization in extremely underweight adults with AN without increasing the risk of RS. View Full-Text
Keywords: anorexia nervosa; caloric intake; refeeding syndrome; refeeding protocol anorexia nervosa; caloric intake; refeeding syndrome; refeeding protocol
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Koerner, T.; Haas, V.; Heese, J.; Karacic, M.; Ngo, E.; Correll, C.U.; Voderholzer, U.; Cuntz, U. Outcomes of an Accelerated Inpatient Refeeding Protocol in 103 Extremely Underweight Adults with Anorexia Nervosa at a Specialized Clinic in Prien, Germany. J. Clin. Med. 2020, 9, 1535.

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