What is Re-feeding Syndrome?

Health Complications in Anorexia Recovery

Feb 15, 2010 Kate Le Page

Re-feeding Anorexia Patients Require Monitoring - V2

What is nasogastric feeding and what complications may be associated with the re-feeding
process?

Re-feeding is the main way that the anorexia sufferer will begin to restore the necessary weight
required to be a healthy BMI. Ideally, support to achieve weight restoration will be provided by a
nutritionist with experience of working within the field of eating disorders and with the regular
support of a therapist. While artificial means of re-feeding are only used as a last resort, such
approaches may be deemed in some cases as essential to safeguarding the patient's life. Key
areas to be explored in this article are now listed below.

• What is nasogastric feeding?

• What is re-feeding syndrome?
• Further complications associated with re-feeding

What is Nasogastric Feeding?

Nasogastric feeding is an artificial method of feeding only required in extreme circumstances

and involves the patient being fed through a nasogastric tube. It is important to highlight that
such an approach is often damaging to the therapeutic relationship and may only be carried out
under strict supervision.

What is Re-feeding Syndrome?

Re-feeding Syndrome is the term commonly used to describe a variety of different electrolyte
disturbances which may occur during the process of re-feeding. It is for this reason that the
patient's levels of essential minerals such as potassium, calcium and magnesium must be closely
monitored, particularly at the beginning of treatment. This syndrome is more commonly seen in
severely underweight, malnourished patients and severe complications may arise as a result of
the individual receiving too much food too soon.

Further Complications Associated with Re-feeding

Complications associated with re-feeding may be divided into four groups including the
following: electrolyte disturbances (as previously highlighted), gastrointestinal dysfunction, re-
feeding edema and cardiac complications. Gastrointestinal issues commonly include symptoms
such as constipation, abdominal plain, bloating and feeling overly full as a result of delayed
gastric emptying. Re-feeding edema may result in a high increase of fluid within the blood
vessels in turn causing swelling to occur in the patient's hands, feet and ankles. Cardiac
complications such as impaired cardiac function or even cardiac failure are also more frequent in
artificial re-feeding methods.

To conclude, it is important that patients are educated about the possible complications of re-
feeding as well as reassured that common symptoms such as delayed gastric emptying will
resolve in time. Throughout the re-feeding period it is advisable that the patient is regularly
monitored and this is particularly crucial in the early stages.

Sources:

Abraham, S. & Llewellyn-Jones, D. (1997) Eating Disorders: The Facts Oxford University Press

Shepphird, S. (2010) 100 Questions & Answers About Anorexia Nervosa Massachussets: Jones
& Bartlett

Treasure et al. (2003) Handbook of Eating Disorders Chichester: John Wiley & Sons

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