CARDIAC-ARREST AND DELIRIUM - PRESENTATIONS OF THE REFEEDING SYNDROMEIN SEVERELY MALNOURISHED ADOLESCENTS WITH ANOREXIA-NERVOSA

Aim: To describe the clinical presentation of the refeeding syndrome a nd highlight the dangers of performing nutritional rehabilitation too rapidly in a severely malnourished patient. Design: Retrospective case review of adolescents admitted with anorexia nervosa who developed th e refeeding syndrome. Results: Between July 1993 and July 1994, 3 of 4 8 adolescent females developed the refeeding syndrome. While the cardi ac complications occurred in the first week of refeeding, the delirium characteristic of this syndrome occurred later and was more variably related to hypophosphatemia. Observations: Refeeding malnourished pati ents with anorexia nervosa can be associated with hypophosphatemia, ca rdiac arrhythmia and delirium. Refeeding patients with anorexia nervos a who are <70% of ideal body weight should proceed with caution, and t he caloric prescription should be increased gradually. Supplemental ph osphorus 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 monitori ng of electrolyte and cardiac status. (C) Society for Adolescent Medic ine, 1998.