Refeeding syndrome in patients with Anorexia Nervosa. Procedures to detect and treat patients at risk of refeeding syndrome in regional departments of eating disorders in Norway and nutrient contents of the basic reference menu at Regional Department of Eating Disorders (RASP)
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Background Anorexia nervosa (AN) is a disorder recognized by underweight and psychiatric symptoms, and some patients are at risk of developing refeeding syndrome (RFS). AN patients may experience metabolic disturbances and severe symptoms during refeeding, and international guidelines in how to refeed AN patients at risk of RFS varies. The regional departments of eating disorders (EDs) in Norway treat about 100-200 patients every year with AN, and a survey investigating procedures have not been performed before. Aim This master thesis has investigated how physicians and registered dietitians (RDs) in the departments of EDs in Norway consider RFS, and how they refeed and monitor patients with AN. Due to the complications and problems that may occur during refeeding in high-risk groups like AN, it was of interest to investigate if procedures, knowledge and awareness varied between the ED units and if the basic reference menu at RASP contain the energy and micronutrients that is recommended for AN patients during refeeding. Method Procedures, questionnaires and analysis of the basic reference menu at RASP have been collected and analyzed. The procedures were collected by contacting the head physicians at the different regional departments of EDs by mail. The master student designed the questionnaire, with assistance from the RDs and supervisor at RASP. The four-week rollover dinner menu at RASP was weighed, photographed and nutritional content calculated. The average nutrient content of the dinners was analyzed together with the other meals (breakfast, lunch, and evening meal) in the basic menu/ and half of the basic menu to evaluate the yield of important nutrients trough one day. Results Three out of six regional departments of EDs have a procedure to identify and/or treat patients at risk of RFS. Initial refeeding range of energy in the procedures varied between 10-30 kcal/kg/body weight, or half dietary lists (1000-1500 kcal). RFS is a rare syndrome in the ED III units. Only one clinician at one of the ED units had ever seen a patient with full-blown RFS. The basic reference menu at RASP covers the recommendations of most nutrients. Half basic reference menu contains more energy than most international guidelines recommended for patients at risk of RFS. The energy contents in dinner portions in the basic reference menu contain an average of about 480kcal. Conclusion The procedures of RFS vary between the regional departments of EDs in Norway. A closer collaboration between the units may be favorable, and all units ought to have procedures to identify and treat patients at risk of RFS. The knowledge and awareness of RFS among physicians and RDs working at an ED unit in Norway are good. However, the questionnaire detected that there are some uncertainties both among the physicians and RDs about the definition of RFS. The energy prescribed in Halv grunnmeny" is higher than most of the international guidelines for initial refeeding of patients at risk of RFS. The basic reference menu makes an important frame for and is a good guidance for the milieu therapists that serve the patients during the nutritional rehabilitation at RASP. Supplementation of omega 3, vitamin D and iron should be assessed.