Severe anorexia nervosa: Outcomes from a medical stabilization unit

Jennifer L. Gaudiani; Allison Lee Sabel; Margherita Mascolo; Philip S. Mehler

doi:10.1002/eat.20889

Severe anorexia nervosa: Outcomes from a medical stabilization unit

International Journal of Eating Disorders ◽

10.1002/eat.20889 ◽

2010 ◽

Vol 45 (1) ◽

pp. 85-92 ◽

Cited By ~ 63

Author(s):

Jennifer L. Gaudiani ◽

Allison Lee Sabel ◽

Margherita Mascolo ◽

Philip S. Mehler

Keyword(s):

Anorexia Nervosa ◽

Medical Stabilization

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The Effect of Malnourishment on Venous Blood Gases in Adolescents with Anorexia Nervosa Hospitalized for Medical Stabilization. A Retrospective Study

Journal of Adolescent Health ◽

10.1016/j.jadohealth.2009.11.123 ◽

2010 ◽

Vol 46 (2) ◽

pp. S51

Author(s):

Nogah Kerem ◽

Elvira Everin ◽

Arieh Riskin ◽

Amir Kugelman

Keyword(s):

Anorexia Nervosa ◽

Retrospective Study ◽

Venous Blood ◽

Blood Gases ◽

Medical Stabilization

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

Journal of Clinical Medicine ◽

10.3390/jcm9051535 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1535 ◽

Cited By ~ 2

Author(s):

Thorsten Koerner ◽

Verena Haas ◽

Julia Heese ◽

Matislava Karacic ◽

Elmar Ngo ◽

...

Keyword(s):

Anorexia Nervosa ◽

Retrospective Chart Review ◽

Blood Parameters ◽

Medical Monitoring ◽

Refeeding Syndrome ◽

Total Weight Gain ◽

Medical Stabilization ◽

Continuous Normalization ◽

Parameter Monitoring

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.

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What’s at the Heart of Anorexia Nervosa? Reconsidering the Physiology of Bradycardia in Anorexia Nervosa

10.31234/osf.io/eza6y ◽

2018 ◽

Author(s):

James Heathers ◽

Jason Nagata ◽

Stuart Murray

Keyword(s):

Heart Rate ◽

Weight Loss ◽

Anorexia Nervosa ◽

Psychiatric Disorders ◽

Central Feature ◽

Resting Heart Rate ◽

Cardiovascular Exercise ◽

Medical Risk ◽

Precision Management ◽

Medical Stabilization

Anorexia nervosa (AN)is among the most pernicious, and lethal,of psychiatric disorders, in which starvation-inducedmedical instability oftenrequiresimmediate hospitalization. In mitigating this medical risk, currentguidelines posit that bradycardia, defined as a resting heart rate of less than 50 beats per minute,may serve as a biomarker from which we can infer medical instability in those with AN, with those meeting this criterion requiringurgent hospitalization, medical stabilization and refeeding. However, alongside dietary starvation, a central feature of AN relates to cardiovascular exercise, which is often excessively undertaken as a means to further augment weight loss. Crucially, frequent and intense cardiovascular exercise may also lower one’s resting heart rate, leaving two potential mechanisms underpinning bradycardia in those with AN, which potentially portend differential risk profiles. Here we briefly review the potential co-contribution of exercise and starvation to bradycardia in those with AN, and suggest that the precise delineation of factors underpinning bradycardia in those with AN, and the relative degree of risk therein, is crucial in the precision management of AN.

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