Refeeding syndrome influences outcome of anorexia nervosa patients in intensive care unit: an observational study

Marie Vignaud, Jean-Michel Constantin, Marc Ruivard, Michele Villemeyre-Plane, Emmanuel Futier, Jean-Etienne Bazin, Djillali Annane, AZUREA group (AnorexieRea Study Group), Sophie Cayot Constantin, Renaud Guerin, Matthieu Jabaudon, Christian Chartier, Sebastien Perbet, Antoine Petit, Samir Jaber, Gerald Chanques, Philippe Verdier, Robert Chausset, Dominique Guelon, Claude Guerin, Laurent Papazian, Jean Paul Mira, Bernard Blettery, Bernard Claud, Jean Yves Lefrant, Jean Michel Arnal, Carole Ichai, Olivier Leroy, Benoît Valet, Olivier Pajot, Bernard Garrigues, Marie Vignaud, Jean-Michel Constantin, Marc Ruivard, Michele Villemeyre-Plane, Emmanuel Futier, Jean-Etienne Bazin, Djillali Annane, AZUREA group (AnorexieRea Study Group), Sophie Cayot Constantin, Renaud Guerin, Matthieu Jabaudon, Christian Chartier, Sebastien Perbet, Antoine Petit, Samir Jaber, Gerald Chanques, Philippe Verdier, Robert Chausset, Dominique Guelon, Claude Guerin, Laurent Papazian, Jean Paul Mira, Bernard Blettery, Bernard Claud, Jean Yves Lefrant, Jean Michel Arnal, Carole Ichai, Olivier Leroy, Benoît Valet, Olivier Pajot, Bernard Garrigues

Abstract

Introduction: Data on the epidemiology and management of anorexia nervosa (AN) in the intensive care unit (ICU) are scarce. The aim of this study was to evaluate the prevalence and associated morbidity and mortality of AN in French ICUs.

Methods: We randomly selected 30 ICUs throughout France. Thereafter, we retrospectively analyzed all patients with AN admitted to any of these 30 ICUs between May 2006 and May 2008. We considered demographic data, diagnosis at admission and complications occurring during the stay, focusing on refeeding syndrome and management of refeeding.

Results: Eleven of the 30 ICUs participated in the retrospective study, featuring 68 patients, including 62 women. Average body mass index at the admission was 12 ± 3 kg/m2. Twenty one were mechanically ventilated, mainly for neurological reasons. The reported average calorie intake was 22.3 ± 13 kcal/kg/24 h. Major diagnoses at admission were metabolic problems, refeeding survey and voluntary drug intoxication and infection. The most common complications were metabolic, hematological, hepatic, and infectious events, of which 10% occurred during refeeding. Seven patients developed refeeding syndrome. At day one, the average calorie intake was higher for patients who developed refeeding syndrome (23.2 ± 5 Kcal/kg/j; n = 7) versus patients without refeeding syndrome (14.1 ± 3 Kcal/kg/j; n = 61) P = 0.02. Seven patients died, two from acute respiratory distress syndrome and five from multiorgan-failure associated with major hydroelectrolytic problems.

Conclusions: The frequency of AN in ICU patients is very low and the crude mortality in this group is about 10%. Prevention and early-detection of refeeding syndrome is the key point.

Figures

Figure 1
Figure 1
Reasons for admission to the ICU. The reason for admission was the main diagnosis at admission. No associated diagnosis was considered. Data are expressed as percentages of patients.

References

    1. Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord. 2003;34:383–396. doi: 10.1002/eat.10222.
    1. Walsh BT, Kaplan AS, Attia E, Olmsted M, Parides M, Carter JC, Pike KM, Devlin MJ, Woodside B, Roberto CA, Rockert W. Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. JAMA. 2006;295:2605–2612. doi: 10.1001/jama.295.22.2605.
    1. Fairburn CG, Cowen PJ, Harrison PJ. Twin studies and the etiology of eating disorders. Int J Eat Disord. 1999;26:349–358. doi: 10.1002/(SICI)1098-108X(199912)26:4<349::AID-EAT1>;2-B.
    1. Miller JJ 3rd, Ammerman S, Parker BR. Anorexia nervosa presenting as a peripheral vasculopathy in an adolescent male. J Rheumatol. 1995;22:544–547.
    1. Steinhausen HC. The outcome of anorexia nervosa in the 20th century. Am J Psychiatry. 2002;159:1284–1293. doi: 10.1176/appi.ajp.159.8.1284.
    1. Zipfel S, Lowe B, Reas DL, Deter HC, Herzog W. Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study. Lancet. 2000;355:721–722. doi: 10.1016/S0140-6736(99)05363-5.
    1. Ben-Tovim DI, Walker K, Gilchrist P, Freeman R, Kalucy R, Esterman A. Outcome in patients with eating disorders: a 5-year study. Lancet. 2001;357:1254–1257. doi: 10.1016/S0140-6736(00)04406-8.
    1. Lowe B, Zipfel S, Buchholz C, Dupont Y, Reas DL, Herzog W. Long-term outcome of anorexia nervosa in a prospective 21-year follow-up study. Psychol Med. 2001;31:881–890. doi: 10.1017/S003329170100407X.
    1. Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 2008;336:1495–1498. doi: 10.1136/bmj.a301.
    1. National Institute for Health and Clinical Excellence. Nutrition support in adults: full guideline (CG32)
    1. Marik PE, Bedigian MK. Refeeding hypophosphatemia in critically ill patients in an intensive care unit. A prospective study. Arch Surg. 1996;131:1043–1047.
    1. Solomon SM, Kirby DF. The refeeding syndrome: a review. JPEN J Parenter Enteral Nutr. 1990;14:90–97. doi: 10.1177/014860719001400190.
    1. Rigaud D, Brondel L, Poupard AT, Talonneau I, Brun JM. A randomized trial on the efficacy of a 2-month tube feeding regimen in anorexia nervosa: A 1-year follow-up study. Clin Nutr. 2007;26:421–429. doi: 10.1016/j.clnu.2007.03.012.
    1. Pertschuk MJ, Forster J, Buzby G, Mullen JL. The treatment of anorexia nervosa with total parenteral nutrition. Biol Psychiatry. 1981;16:539–550.
    1. Diamanti A, Basso MS, Castro M, Bianco G, Ciacco E, Calce A, Caramadre AM, Noto C, Gambarara M. Clinical efficacy and safety of parenteral nutrition in adolescent girls with anorexia nervosa. J Adolesc Health. 2008;42:111–118. doi: 10.1016/j.jadohealth.2007.09.024.
    1. Cartwright MM. Eating disorder emergencies: understanding the medical complexities of the hospitalized eating disordered patient. Crit Care Nurs Clin North Am. 2004;16:515–530.
    1. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348:1123–1133. doi: 10.1056/NEJMra011883.
    1. Lichtenstein D, Saifi R, Augarde R, Prin S, Schmitt JM, Page B, Pipien I, Jardin F. The Internal jugular veins are asymmetric. Usefulness of ultrasound before catheterization. Intensive Care Med. 2001;27:301–305. doi: 10.1007/s001340000792.
    1. Raad I. Intravascular-catheter-related infections. Lancet. 1998;351:893–898. doi: 10.1016/S0140-6736(97)10006-X.
    1. Morris J, Twaddle S. Anorexia nervosa. BMJ. 2007;334:894–898. doi: 10.1136/.
    1. Lupoglazoff JM, Berkane N, Denjoy I, Maillard G, Leheuzey MF, Mouren-Simeoni MC, Casasoprana A. [Cardiac consequences of adolescent anorexia nervosa] Arch Mal Coeur Vaiss. 2001;94:494–498.
    1. Inui A, Uemoto M, Seki W, Ueno N, Morita S, Baba S, Kasuga M. Rebound hypoglycaemia after intravenous glucose in anorexia nervosa. Lancet. 1996;347:323–324. doi: 10.1016/S0140-6736(96)90497-3.
    1. Zazzo JF, Troche G, Ruel P, Maintenant J. High incidence of hypophosphatemia in surgical intensive care patients: efficacy of phosphorus therapy on myocardial function. Intensive Care Med. 1995;21:826–831. doi: 10.1007/BF01700966.
    1. Mickley D, Greenfeld D, Quinlan DM, Roloff P, Zwas F. Abnormal liver enzymes in outpatients with eating disorders. Int J Eat Disord. 1996;20:325–329. doi: 10.1002/(SICI)1098-108X(199611)20:3<325::AID-EAT13>;2-Z.
    1. Tsukamoto M, Tanaka A, Arai M, Ishii N, Ohta D, Horiki N, Fujita Y. Hepatocellular injuries observed in patients with an eating disorder prior to nutritional treatment. Intern Med. 2008;47:1447–1450. doi: 10.2169/internalmedicine.47.0824.
    1. Kerem NC, Katzman DK. Brain structure and function in adolescents with anorexia nervosa. Adolesc Med. 2003;14:109–118.
    1. Nishio S, Yamada H, Yamada K, Okabe H, Okuya T, Yonekawa O, Ono T, Sahara N, Tamashima S, Ihara M. Severe neutropenia with gelatinous bone marrow transformation in anorexia nervosa: a case report. Int J Eat Disord. 2003;33:360–363. doi: 10.1002/eat.10143.
    1. Kaiser U, Barth N. Haemolytic anaemia in a patient with anorexia nervosa. Acta Haematol. 2001;106:133–135. doi: 10.1159/000046604.
    1. Marcos A. The immune system in eating disorders: an overview. Nutrition. 1997;13:853–862. doi: 10.1016/S0899-9007(97)00272-4.
    1. Pomeroy C, Eckert E, Hu S, Eiken B, Mentink M, Crosby RD, Chao CC. Role of interleukin-6 and transforming growth factor-beta in anorexia nervosa. Biol Psychiatry. 1994;36:836–839. doi: 10.1016/0006-3223(94)90594-0.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅