To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol
Inadequate nutritional rehabilitation of severely malnourished adolescents with Anorexia Nervosa (AN) increases the risk of medical complications. There is no consensus on best practices for inpatient nutritional rehabilitation and medical stabilization for severe AN. This study aimed to elaborate a...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-01-01
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| Series: | Nutrients |
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| Online Access: | https://www.mdpi.com/2072-6643/14/1/229 |
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| author | Stephanie Proulx-Cabana Marie-Elaine Metras Danielle Taddeo Olivier Jamoulle Jean-Yves Frappier Chantal Stheneur |
| author_facet | Stephanie Proulx-Cabana Marie-Elaine Metras Danielle Taddeo Olivier Jamoulle Jean-Yves Frappier Chantal Stheneur |
| author_sort | Stephanie Proulx-Cabana |
| collection | DOAJ |
| description | Inadequate nutritional rehabilitation of severely malnourished adolescents with Anorexia Nervosa (AN) increases the risk of medical complications. There is no consensus on best practices for inpatient nutritional rehabilitation and medical stabilization for severe AN. This study aimed to elaborate an admission protocol for adolescents with severe AN based on a comprehensive narrative review of current evidence. A Pubmed search was conducted in July 2017 and updated in August 2020, using the keywords severe AN or eating disorders (ED), management guidelines and adolescent. Relevant references cited in these guidelines were retrieved. A secondary search was conducted using AN or ED and refeeding protocol, refeeding syndrome (RS), hypophosphatemia, hypoglycemia, cardiac monitoring or cardiac complications. Evidence obtained was used to develop the admission protocol. Selective blood tests were proposed during the first three days of nutritional rehabilitation. Higher initial caloric intake is supported by evidence. Continuous nasogastric tube feeding was proposed for patients with a BMI < 12 kg/m2. We monitor hypoglycemia for 72 h. Continuous cardiac monitoring for bradycardia <30 BPM and systematic phosphate supplementation should be considered. Developing protocols is necessary to improve standardization of care. We provide an example of an inpatient admission protocol for adolescents with severe AN. |
| first_indexed | 2024-03-10T03:27:14Z |
| format | Article |
| id | doaj.art-a6555bdd5a2a4f529a6157198bec6904 |
| institution | Directory Open Access Journal |
| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-10T03:27:14Z |
| publishDate | 2022-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Nutrients |
| spelling | doaj.art-a6555bdd5a2a4f529a6157198bec69042023-11-23T12:06:12ZengMDPI AGNutrients2072-66432022-01-0114122910.3390/nu14010229To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient ProtocolStephanie Proulx-Cabana0Marie-Elaine Metras1Danielle Taddeo2Olivier Jamoulle3Jean-Yves Frappier4Chantal Stheneur5Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC H3T 1C5, CanadaPharmacy Department, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC H3T 1C5, CanadaPediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC H3T 1C5, CanadaPediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC H3T 1C5, CanadaPediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC H3T 1C5, CanadaCESP, UVSQ, INSERM U 1178, Paris-Saclay University, 94805 Villejuif, FranceInadequate nutritional rehabilitation of severely malnourished adolescents with Anorexia Nervosa (AN) increases the risk of medical complications. There is no consensus on best practices for inpatient nutritional rehabilitation and medical stabilization for severe AN. This study aimed to elaborate an admission protocol for adolescents with severe AN based on a comprehensive narrative review of current evidence. A Pubmed search was conducted in July 2017 and updated in August 2020, using the keywords severe AN or eating disorders (ED), management guidelines and adolescent. Relevant references cited in these guidelines were retrieved. A secondary search was conducted using AN or ED and refeeding protocol, refeeding syndrome (RS), hypophosphatemia, hypoglycemia, cardiac monitoring or cardiac complications. Evidence obtained was used to develop the admission protocol. Selective blood tests were proposed during the first three days of nutritional rehabilitation. Higher initial caloric intake is supported by evidence. Continuous nasogastric tube feeding was proposed for patients with a BMI < 12 kg/m2. We monitor hypoglycemia for 72 h. Continuous cardiac monitoring for bradycardia <30 BPM and systematic phosphate supplementation should be considered. Developing protocols is necessary to improve standardization of care. We provide an example of an inpatient admission protocol for adolescents with severe AN.https://www.mdpi.com/2072-6643/14/1/229Anorexia Nervosaadolescentinpatientmedical stabilizationrefeeding syndrome |
| spellingShingle | Stephanie Proulx-Cabana Marie-Elaine Metras Danielle Taddeo Olivier Jamoulle Jean-Yves Frappier Chantal Stheneur To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol Nutrients Anorexia Nervosa adolescent inpatient medical stabilization refeeding syndrome |
| title | To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol |
| title_full | To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol |
| title_fullStr | To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol |
| title_full_unstemmed | To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol |
| title_short | To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol |
| title_sort | to improve the initial inpatient management of adolescents admitted with severe anorexia nervosa a narrative review and a convenient protocol |
| topic | Anorexia Nervosa adolescent inpatient medical stabilization refeeding syndrome |
| url | https://www.mdpi.com/2072-6643/14/1/229 |
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