Gentile Maria Gabriella, Lessa Chiara, Cattaneo Marina
Eating Disorders Unit, Niguarda Hospital, Milan Italy.
Clin Med Insights Case Rep. 2013 Apr 1;6:51-6. doi: 10.4137/CCRep.S11471. Print 2013.
Anorexia nervosa exhibits one of the highest death rates among psychiatric patients and a relevant fraction of it is derived from undernutrition. Nutritional and medical treatment of extreme undernutrition present two very complex and conflicting tasks: (1) to avoid "refeeding syndrome" caused by a too fast correction of malnutrition; and (2) to avoid "underfeeding" caused by a too cautious refeeding. To obtain optimal treatment results, the caloric intake should be planned starting with indirect calorimetry measurements and electrolyte abnormalities accurately controlled and treated. This article reports the case of an anorexia nervosa young female affected by extreme undernutrition (BMI 9.6 kg/m(2)) who doubled her admission body weight (from 22.5 kg to 44 kg) in a reasonable time with the use of enteral tube feeding for gradual correction of undernutrition. Refeeding syndrome was avoided through a specialized and flexible program according to clinical, laboratory, and physiological findings.
神经性厌食症在精神科患者中死亡率极高，其中相当一部分是由营养不良导致的。对极度营养不良进行营养和医学治疗面临两项非常复杂且相互矛盾的任务：（1）避免因过快纠正营养不良而引发“再喂养综合征”；（2）避免因喂养过于谨慎而导致“喂养不足”。为获得最佳治疗效果，应从间接测热法测量开始规划热量摄入，并准确控制和治疗电解质异常。本文报告了一名患有极度营养不良（体重指数9.6 kg/m²）的神经性厌食症年轻女性的病例，通过使用肠内管饲法逐步纠正营养不良，她在合理时间内体重增加了一倍（从22.5千克增至44千克）。通过根据临床、实验室和生理检查结果制定的专门且灵活的方案，避免了再喂养综合征的发生。
