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Excessive laboratory monitoring to prevent adolescent’s refeeding syndrome: opportunities for enhancement

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

Anorexia nervosa (AN) is a complex medical condition affecting mainly adolescents and young adults. To monitor and prevent refeeding syndrome, current guidelines recommend daily laboratory testing in the first week of hospitalization and 2–3 times/week for the following 3 weeks. The aims of this study were to determine the proportion of abnormal results of the blood tests done during the first week of nutritional rehabilitation in adolescents with AN, the proportion of test having led to supplementation and the cost of all these tests.

Method

A retrospective chart review of admissions for eating disorders between May 2014 and May 2015 in a tertiary Pediatric University Hospital center was performed. Patients were included if they were younger than 18 years, admitted for protocol-based refeeding and met criteria for AN (DSM 5).

Results

Among the 99 hospitalizations included in the study, the mean age was 14.6 years (± 1.7), with a female predominance (97%). The mean admission BMI was 15.3 ± 2 kg/m2 (Z-score − 2.6 ± 1.4). The mean length of hospitalization was 40.3 days ± 21.8. Of the 1289 laboratory tests performed, only 1.5% revealed abnormal values and 0.85% led to supplementation. No critical value was identified. The total cost for the tests performed was 148,926.80 CAD$, 1504$/admitted patient, instead of 3890$/admitted patient had we followed the recommendations.

Conclusion

More precise criteria should be developed regarding the frequency of laboratory tests needed to monitor and prevent refeeding syndrome. At present, the recommendations could lead to unnecessary testing and expenses.

Level of evidence

Level IV: Dramatic results in uncontrolled trials.

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References

  1. Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR (2011) Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry 68(7):714–723. https://doi.org/10.1001/archgenpsychiatry.2011.22

    Article  PubMed  PubMed Central  Google Scholar 

  2. Arcelus J, Mitchell AJ, Wales J, Nielsen S (2011) Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 68(7):724–731. https://doi.org/10.1001/archgenpsychiatry.2011.74

    Article  PubMed  Google Scholar 

  3. Berkman ND, Lohr KN, Bulik CM (2007) Outcomes of eating disorders: a systematic review of the literature. Int J Eat Disord 40(4):293–309. https://doi.org/10.1002/eat.20369

    Article  PubMed  Google Scholar 

  4. Hoek HW (2006) Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Curr Opin Psychiatry 19(4):389–394. https://doi.org/10.1097/01.yco.0000228759.95237.78

    Article  PubMed  Google Scholar 

  5. Steinhausen HC (2002) The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 159(8):1284–1293

    Article  PubMed  Google Scholar 

  6. Steinhausen HC (2009) Outcome of eating disorders. Child Adolesc Psychiatr Clin N Am 18(1):225–242. https://doi.org/10.1016/j.chc.2008.07.013

    Article  PubMed  Google Scholar 

  7. Lindblad F, Lindberg L, Hjern A (2006) Improved survival in adolescent patients with anorexia nervosa: a comparison of two Swedish national cohorts of female inpatients. Am J Psychiatry 163(8):1433–1435. https://doi.org/10.1176/appi.ajp.163.8.1433

    Article  PubMed  Google Scholar 

  8. Huas C, Caille A, Godart N, Foulon C, Pham-Scottez A, Divac S, Dechartres A, Lavoisy G, Guelfi JD, Rouillon F, Falissard B (2011) Factors predictive of ten-year mortality in severe anorexia nervosa patients. Acta Psychiatr Scand 123(1):62–70. https://doi.org/10.1111/j.1600-0447.2010.01627.x

    Article  CAS  PubMed  Google Scholar 

  9. Tric LAG, Tran D, Godart N, Benmansour EL, Lamer C (2004) Management of anorexia nervosa in intensive care unit. Reanimation 13:407–4016

    Article  Google Scholar 

  10. Crook MA (2014) Refeeding syndrome: problems with definition and management. Nutrition (Burbank, Los Angeles County, Calif) 30(11–12):1448–1455. https://doi.org/10.1016/j.nut.2014.03.026

    Article  Google Scholar 

  11. Friedli N, Stanga Z, Sobotka L, Culkin A, Kondrup J, Laviano A, Mueller B, Schuetz P (2017) Revisiting the refeeding syndrome: results of a systematic review. Nutrition (Burbank, Los Angeles County, Calif) 35:151–160. https://doi.org/10.1016/j.nut.2016.05.016

    Article  Google Scholar 

  12. O’Connor G, Nicholls D (2013) Refeeding hypophosphatemia in adolescents with anorexia nervosa: a systematic review. Nutr Clin Pract 28(3):358–364. https://doi.org/10.1177/0884533613476892

    Article  PubMed  PubMed Central  Google Scholar 

  13. Brown C, Mehler PS (2015) Medical complications of anorexia nervosa and their treatments: an update on some critical aspects. Eat Weight Disord 20(4):419–425. https://doi.org/10.1007/s40519-015-0202-3

    Article  PubMed  Google Scholar 

  14. Kameoka N, Iga J, Tamaru M, Tominaga T, Kubo H, Watanabe SY, Sumitani S, Tomotake M, Ohmori T (2016) Risk factors for refeeding hypophosphatemia in Japanese inpatients with anorexia nervosa. Int J Eat Disord 49(4):402–406. https://doi.org/10.1002/eat.22472

    Article  PubMed  Google Scholar 

  15. Katzman DK, Garber AK, Kohn M, Golden NH (2014) Refeeding hypophosphatemia in hospitalized adolescents with anorexia nervosa: a position statement of the Society for Adolescent Health and Medicine. J Adolesc Health 55(3):455–457. https://doi.org/10.1016/j.jadohealth.2014.06.010

    Article  PubMed Central  Google Scholar 

  16. Marikar D, Reynolds S, Moghraby OS (2016) Junior MARSIPAN (Management of Really Sick Patients with Anorexia Nervosa). Archiv Dis Childh Educ Pract Ed 101(3):140–143. https://doi.org/10.1136/archdischild-2015-308679

    Article  Google Scholar 

  17. National Institut for Health and Clinical Excellence (2004) Eating disorders: core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders CG9. http://www.niceorguk/CG009NICEguideline

  18. Bell C, Bulik C, Clayton P, Crow S, Davis DM, DeMaso DR, Dogin J, Fairburn CG, Fink AH, Fisher M, Forman S (2000) Practice guideline for the treatment of patients with eating disorders (revision). American Psychiatric Association Work Group on Eating Disorders. Am J Psychiatry 157(1):1–39

    Article  Google Scholar 

  19. Garber AK, Michihata N, Hetnal K, Shafer MA, Moscicki AB (2012) A prospective examination of weight gain in hospitalized adolescents with anorexia nervosa on a recommended refeeding protocol. J Adolesc Health 50(1):24–29. https://doi.org/10.1016/j.jadohealth.2011.06.011

    Article  PubMed  Google Scholar 

  20. Leclerc A, Turrini T, Sherwood K, Katzman DK (2013) Evaluation of a nutrition rehabilitation protocol in hospitalized adolescents with restrictive eating disorders. J Adolesc Health 53(5):585–589. https://doi.org/10.1016/j.jadohealth.2013.06.001

    Article  PubMed  Google Scholar 

  21. Redgrave GW, Coughlin JW, Schreyer CC, Martin LM, Leonpacher AK, Seide M, Verdi AM, Pletch A, Guarda AS (2015) Refeeding and weight restoration outcomes in anorexia nervosa: challenging current guidelines. Int J Eat Disord 48(7):866–873. https://doi.org/10.1002/eat.22390

    Article  PubMed  Google Scholar 

  22. O’Connor G, Nicholls D, Hudson L, Singhal A (2016) Refeeding low weight hospitalized adolescents with anorexia nervosa: a multicenter randomized controlled trial. Nutr Clin Pract. https://doi.org/10.1177/0884533615627267

    Article  PubMed  Google Scholar 

  23. Golden NH, Keane-Miller C, Sainani KL, Kapphahn CJ (2013) Higher caloric intake in hospitalized adolescents with anorexia nervosa is associated with reduced length of stay and no increased rate of refeeding syndrome. J Adolesc Health 53(5):573–578. https://doi.org/10.1016/j.jadohealth.2013.05.014

    Article  PubMed  Google Scholar 

  24. Bargiacchi A, Clarke J, Paulsen A, Leger J (2019) Refeeding in anorexia nervosa. Eur J Pediatr 178(3):413–422. https://doi.org/10.1007/s00431-018-3295-7

    Article  PubMed  Google Scholar 

  25. Garber AK, Sawyer SM, Golden NH, Guarda AS, Katzman DK, Kohn MR, Le Grange D, Madden S, Whitelaw M, Redgrave GW (2016) A systematic review of approaches to refeeding in patients with anorexia nervosa. Int J Eat Disord 49(3):293–310. https://doi.org/10.1002/eat.22482

    Article  PubMed  Google Scholar 

  26. HAS (2010) Anorexie mentale: prise en charge. Recommendations pour la pratique clinique. HAS, Cambridge

    Google Scholar 

  27. Kaplan DW, Diaz A, Blythe MJ, Feinstein RA (2003) Identifying and treating eating disorders. Pediatrics 111(1):204–211. https://doi.org/10.1542/peds.111.1.204

    Article  Google Scholar 

  28. Beumont P, Hay P, Beumont D, Birmingham L, Derham H, Jordan A, Kohn M, McDermott B, Marks P, Mitchell J, Paxton S, Surgenor L, Thornton C, Wakefield A, Weigall S, Royal A, New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Anorexia N (2004) Australian and New Zealand clinical practice guidelines for the treatment of anorexia nervosa. Aust N Z J Psychiatry 38(9):659–670. https://doi.org/10.1111/j.1440-1614.2004.01449.x

    Article  PubMed  Google Scholar 

  29. Golden NH, Katzman DK, Sawyer SM, Ornstein RM, Rome ES, Garber AK, Kohn M, Kreipe RE (2015) Position paper of the society for adolescent health and medicine: medical management of restrictive eating disorders in adolescents and young adults. J Adolesc Health 56(1):121–125. https://doi.org/10.1016/j.jadohealth.2014.10.259

    Article  PubMed  Google Scholar 

  30. Brown CA, Sabel AL, Gaudiani JL, Mehler PS (2015) Predictors of hypophosphatemia during refeeding of patients with severe anorexia nervosa. Int J Eat Disord 48(7):898–904. https://doi.org/10.1002/eat.22406

    Article  PubMed  Google Scholar 

  31. Leitner M, Burstein B, Agostino H (2016) Prophylactic phosphate supplementation for the inpatient treatment of restrictive eating disorders. J Adolesc Health 58(6):616–620. https://doi.org/10.1016/j.jadohealth.2015.12.001

    Article  PubMed  Google Scholar 

  32. Ridout KK, Kole J, Fitzgerald KL, Ridout SJ, Donaldson AA, Alverson B (2016) Daily laboratory monitoring is of poor health care value in adolescents acutely hospitalized for eating disorders. J Adolesc Health 59(1):104–109. https://doi.org/10.1016/j.jadohealth.2016.03.015

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada

    Rola Ghaddar, Olivier Jamoulle, Danielle Taddeo, Jean-Yves Frappier & Chantal Stheneur

  2. Montreal University, Montreal, QC, Canada

    Jessica Chartrand, Anass Benomar, Olivier Jamoulle, Danielle Taddeo, Jean-Yves Frappier & Chantal Stheneur

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  1. Rola Ghaddar
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  2. Jessica Chartrand
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  3. Anass Benomar
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  4. Olivier Jamoulle
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  7. Chantal Stheneur
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Correspondence to Chantal Stheneur.

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There was no internal or external funding provided for this research project, and no conflict of interest of any author.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was obtained from the Sainte-Justine’s Hospital Research Ethics Board.

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Informed consent was obtained from all individual participants included in the study.

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Ghaddar, R., Chartrand, J., Benomar, A. et al. Excessive laboratory monitoring to prevent adolescent’s refeeding syndrome: opportunities for enhancement. Eat Weight Disord 25, 1021–1027 (2020). https://doi.org/10.1007/s40519-019-00723-7

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  • DOI: https://doi.org/10.1007/s40519-019-00723-7

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