Multi-electrolyte disturbance and supplementation in severely malnourished hospitalized adolescents with restrictive eating disorders

Eva-Molly Petitto Dunbar; Chase Pribble; Jennifer Cueto; Andrea B Goldschmidt; Christina Tortolani; Abigail A Donaldson

doi:10.1186/s40337-023-00919-4

Multi-electrolyte disturbance and supplementation in severely malnourished hospitalized adolescents with restrictive eating disorders

J Eat Disord. 2023 Nov 15;11(1):202. doi: 10.1186/s40337-023-00919-4.

Authors

Eva-Molly Petitto Dunbar¹, Chase Pribble², Jennifer Cueto^{2

3}, Andrea B Goldschmidt⁴, Christina Tortolani^{2

5}, Abigail A Donaldson^{2

3}

Affiliations

¹ University of California San Diego Eating Disorders Center for Treatment and Research, San Diego, CA, 92121, USA. edunbar@health.ucsd.edu.
² Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI, 02903, USA.
³ Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA.
⁴ University of Pittsburgh School of Medicine, 3711 O'Hara St., Pittsburgh, PA, 15213, USA.
⁵ Rhode Island College, 600 Mount Pleasant Ave., Providence, RI, 02908, USA.

Abstract

Background: This study describes the prevalence of hypophosphatemia, hypokalemia, and/or hypomagnesemia and resulting electrolyte supplementation during refeeding in severely malnourished youths hospitalized for restrictive eating disorders.

Methods: Hospitalized patients between 11-26y (N = 81) at < 75% treatment goal weight (TGW) were assessed through retrospective chart review. Outcomes were compared between participants < 70% TGW and those 70-75% TGW. Nutritional rehabilitation started at 1750 kcals/day and advanced by 500 kcal every other day until target intake was achieved. Associations between %TGW on admission; hypophosphatemia, hypokalemia, and/or hypomagnesemia; and electrolyte supplementation were examined.

Results: Of the 24 (29.6%) participants with hypophosphatemia, hypokalemia, and/or hypomagnesemia, 7 (8.6%) received supplementation; the remainder corrected without supplementation. Participants < 70% TGW did not differ from those 70-75% TGW on rates of these conditions or need for supplementation.

Conclusions: Hospital-based nutritional rehabilitation did not confer increased rates of hypophosphatemia, hypokalemia, and/or hypomagnesemia or need for electrolyte supplementation in patients < 70% TGW compared to those 70-75% TGW. While additional research is needed to establish clinical practice guidelines on electrolyte management in this population, our findings suggest that nutritional rehabilitation may be reasonably undertaken without prophylactic electrolyte supplementation, even in patients < 70% TGW.

Keywords: Adolescents and young adults; Hospitalization; Refeeding; Restrictive eating disorders.

Plain language summary

Identifying safe management methods for nutritional rehabilitation among severely malnourished hospitalized adolescents and young adults with restrictive eating disorders can expedite discharge planning and improve treatment outcomes. In contrast to past studies on inpatient nutritional rehabilitation, this study describes the prevalence and management of multiple-electrolyte disturbance (hypophosphatemia, hypokalemia, and/or hypomagnesemia) during refeeding among hospitalized severely malnourished youths with restrictive eating disorders. We found that in this population, with experienced, close medical supervision, nutritional rehabilitation may be reasonably undertaken without prophylactic electrolyte supplementation, even in patients < 70% goal treatment weight. These findings can inform hospital-based refeeding protocols for adolescents and young adults with restrictive eating disorders, where the practice around prophylactic supplementation is variable.