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Abstract
To describe the clinical presentation of the refeeding syndrome and highlight the
dangers of performing nutritional rehabilitation too rapidly in a severely malnourished
patient.
Retrospective case review of adolescents admitted with anorexia nervosa who developed
the refeeding syndrome.
Between July 1993 and July 1994, 3 of 48 adolescent females developed the refeeding
syndrome. While the cardiac complications occurred in the first week of refeeding,
the delirium characteristic of this syndrome occurred later and was more variably
related to hypophosphatemia.
Refeeding malnourished patients with anorexia nervosa can be associated with hypophosphatemia,
cardiac arrhythmia and delirium. Refeeding patients with anorexia nervosa who are
< 70% of ideal body weight should proceed with caution, and the caloric prescription
should be increased gradually. Supplemental phosphorus should be commenced early and
serum levels maintained above 3.0 mg/dL. Cardiac and neurologic events associated
with refeeding are most likely to occur within the first weeks, justifying close monitoring
of electrolyte and cardiac status.