A conservative refeeding approach in female inpatients with restrictive eating disorders is not protective of refeeding syndrome

The purpose of this study was to describe the effect of a conservative refeeding protocol on rates of hypophosphatemia, hypokalaemia, hypomagnesemia and hypoglycaemia in female inpatients with restrictive eating disorders and explore differences in measured variables in patients reaching medical stability at different stages of hospitalisation. Historical medical records of female, adult patients admitted for treatment from January 2010 to December 2013 were retrospectively reviewed. Demographic characteristics, anthropometric measures, energy prescription and presence of hypophosphatemia (≤0.81mmol/L), hypokalaemia (≤3.5mmol/L) hypomagnesemia (≤0.7mmol/L) and hypoglycaemia (≤4.0mmol/L) at day 1 (admission), day 3, day 7 and day 14 were recorded. Twenty seven female patients were included, mean age 33 (20;35) yrs. Medical stability was reached at 18.6 ± 10.3 days, 63% (n=17/27) reached medical stability ≤14 days of hospitalisation. In the total group, hypoglycaemia (59%, n=16), hypokalaemia (56%, n=15), hypophosphatemia (44%, n=12) and hypomagnesemia (19%, n=5) developed primarily after day 3. Patients who reached medical stability <14 days had significantly higher weight (43 ± 7.4 vs 34 ± 6.7kg; P=0.01) and body mass index (15.2 ± 2.6 vs 12.8 ± 2.7kg/m2; P=0.01) than those reaching medical stability ≥14 days of hospitalisation. Both groups displayed weight loss during the first week. Weight (34.0 vs 36.7kg; P=0.004) and body mass index (12.8 vs 13.8kg/m2; P=0.004) increased significantly from admission to day 14 in patients who reached medical stability ≥14 days of hospitalisation. No difference was found in those reaching MS < 14 days. Patients with restrictive eating disorders receiving a conservative refeeding protocol developed abnormal blood values and displayed reductions in body mass. Further investigation is required before recommending a more appropriate refeeding approach for this population