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Yatırılarak izlenen anoreksiya nervozalı ergenlerde yeniden beslenme döneminde hipofosfatemi gelişme riski

Year 2020, Volume: 14 Issue: 2, 136 - 142, 18.03.2020
https://doi.org/10.12956/tchd.598217

Abstract











Giriş: Anoreksiya nervozada (AN) yeniden beslenme
döneminde, hipofosfatemi en sık görülen elektrolit bozukluğudur ve “refeeding
sendromu” gelişmesi riskini saptamada oldukça duyarlı bir belirteçtir. Yeniden besleme
protokolleri merkezler arasında farklılıklar göstermektedir ve bunların hipofosfatemi
gelişimine etkileri araştırılmaktadır. Bu çalışmanın amacı, merkezimizde AN
tanısı ile izlenen ve yatırılan ergenlerin yeniden beslenme döneminde
hipofosfatemi gelişme oranını ve risk  etmenlerini belirlemektir. Gereç ve Yöntem: Ocak 2010 ve Temmuz
2019 arasında Hacettepe Üniversitesi Çocuk Hastanesi Ergen Sağlığı Bölümünde AN
tanısı ile izlenen ve yatış kriterlerini karşıladığı için beslenme
rehabilitasyonu ve medikal stabilizasyon amacıyla serviste yatırılarak takip
edilen, yaşları 11-18 arasında değişen 58 hastanın 64 yatışına ait dosya
bilgileri geriye dönük olarak yeniden beslenme döneminde hipofosfatemi gelişimi
ve etken olabilecek parametrelere yönelik taranmıştır.  Bulgular:
Toplamda 24 (%37.5) yatış sırasında yeniden beslenme döneminde hipofosfatemi
gelişmiştir ve fosfor desteği verilmiştir. Hipofosfatemi gelişen ve gelişmeyen
hastalar karşılaştırıldığında, hipofosfatemi gelişen grubun
yaş ortalaması daha yüksek (p=0.01),
hastalık başlangıcından yatışa kadar geçen süre daha uzun (p=0.001), kaybedilen
vücut ağırlığı miktarı (p=0.013) ve yüzdesi (p=0.002) daha fazla  ve yatış sırasındaki BKİ z skoru (p=0.001)
anlamlı olarak daha düşük bulunmuştur.
Tartışma:
Bu çalışmada yaş, yatışa kadar geçen hastalık süresi ve malnutrisyon
derecesi yeniden beslenme dönemindeki hipofosfatemi gelişimini belirleyen temel
etmenler olarak bulunmuştur.  Beslenme
protokolünün her hasta özelinde değerlendirilmesi ve özellikle ağır
malnutrisyonlu hasta grubunda daha dikkatli olunması, fosfor seviyelerinin
günlük takibi ve fosfor desteğinin uygun şekilde verilmesi çok önemlidir.

References

  • [1] Kraft MD, Btaiche IF, Sacks GS. Review of the refeeding syndrome. Nutr Clin Pract 2005;20:625-33.
  • [2] Academy of Eating Disorders. Academy for Eating Disorders Report 2016, 3rd Edition: Eating Disorders, A Guide to Medical Care. Erişim tarihi: 25 July 2019. Available from: https://www.aedweb.org/resources/publications/medical-care-standards
  • [3] Bargiacchi A, Clarke J, Paulsen A, Leger J. Refeeding in anorexia nervosa. Eur J Pediatr 2019;178:413-22.
  • [4] Sachs K, Andersen D, Sommer J, Winkelman A, Mehler PS. Avoiding medical complications during the refeeding of patients with anorexia nervosa. Eat Disord 2015;23:411-21.
  • [5] Garber AK, Sawyer SM, Golden NH, Guarda AS, Katzman DK, et al. A systematic review of approaches to refeeding in patients with anorexia nervosa. Int J Eat Disord 2016;49:293-310.
  • [6] Whitelaw M, Gilbertson H, Lam PY, Sawyer SM. Does aggressive refeeding in hospitalized adolescents with anorexia nervosa result in increased hypophosphatemia? J Adolesc Health 2010;46:577-82.
  • [7] Norris ML, Spettigue WJ, Katzman DK. Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatr Dis Treat 2016;12:213-8.
  • [8] Redgrave GW, Coughlin JW, Schreyer CC, Martin LM, Leonpacher AK, et al. Refeeding and weight restoration outcomes in anorexia nervosa: Challenging current guidelines. Int J Eat Disord 2015;48:866-73.
  • [9] Center for Disease Control and Prevention. CDC Growth Charts: Z-score data files. Erişim tarihi: 27 Temmuz 2019. Available from: https://www.cdc.gov/growthcharts/zscore.htm
  • [10] Becker PJ, Nieman Carney L, Corkins MR, Monczka J, Smith E, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). J Acad Nutr Diet 2014;114:1988-2000.
  • [11] Sociery for Adolescent Health and Medicine. Refeeding hypophosphatemia in hospitalized adolescents with anorexia nervosa: a position statement of the Society for Adolescent Health and Medicine. J Adolesc Health 2014;55:455-7.
  • [12] Ornstein RM, Golden NH, Jacobson MS, Shenker IR. Hypophosphatemia during nutritional rehabilitation in anorexia nervosa: implications for refeeding and monitoring. J Adolesc Health 2003;32:83-8.
  • [13] Clark CL, Sacks GS, Dickerson RN, Kudsk KA, Brown RO. Treatment of hypophosphatemia in patients receiving specialized nutrition support using a graduated dosing scheme: results from a prospective clinical trial. Crit Care Med 1995;23:1504-11.
  • [14] Golden NH, Katzman DK, Sawyer SM, Ornstein RM, Rome ES, et al. Position Paper of the Society for Adolescent Health and Medicine: medical management of restrictive eating disorders in adolescents and young adults. J Adolesc Health 2015;56:121-5.
  • [15] Akgül S, Pehlivantürk-Kızılkan M, Örs S, Derman O, Düzçeker Y, et al. Type of setting for the inpatient adolescent with an eating disorder: Are specialized inpatient clinics a must or will the pediatric ward do? Turk J Pediatr 2016;58:641-9.
  • [16] Cuerda C, Vasiloglou MF, Arhip L. Nutritional Management and Outcomes in Malnourished Medical Inpatients: Anorexia Nervosa. J Clin Med 2019;8.
  • [17] Smith K, Lesser J, Brandenburg B, Lesser A, Cici J, et al. Outcomes of an inpatient refeeding protocol in youth with Anorexia Nervosa and atypical Anorexia Nervosa at Children's Hospitals and Clinics of Minnesota. J Eat Disord 2016;4:35.
  • [18] O'Connor G, Nicholls D. Refeeding hypophosphatemia in adolescents with anorexia nervosa: a systematic review. Nutr Clin Pract 2013;28:358-64.
  • [19] Brown CA, Sabel AL, Gaudiani JL, Mehler PS. Predictors of hypophosphatemia during refeeding of patients with severe anorexia nervosa. Int J Eat Disord 2015;48:898-904.
  • [20] Kameoka N, Iga J, Tamaru M, Tominaga T, Kubo H, et al. Risk factors for refeeding hypophosphatemia in Japanese inpatients with anorexia nervosa. Int J Eat Disord 2016;49:402-6.
  • [21] Golden NH, Katzman DK, Sawyer SM, Ornstein RM, Rome ES, et al. Update on the medical management of eating disorders in adolescents. J Adolesc Health 2015;56:370-5.
  • [22] Kohn MR, Madden S, Clarke SD. Refeeding in anorexia nervosa: increased safety and efficiency through understanding the pathophysiology of protein calorie malnutrition. Curr Opin Pediatr 2011;23:390-4.
  • [23] Garber AK, Michihata N, Hetnal K, Shafer MA, Moscicki AB. A prospective examination of weight gain in hospitalized adolescents with anorexia nervosa on a recommended refeeding protocol. J Adolesc Health 2012;50:24-9.
  • [24] Garber AK, Mauldin K, Michihata N, Buckelew SM, Shafer MA, et al. Higher calorie diets increase rate of weight gain and shorten hospital stay in hospitalized adolescents with anorexia nervosa. J Adolesc Health 2013;53:579-84.
  • [25] Leclerc A, Turrini T, Sherwood K, Katzman DK. Evaluation of a nutrition rehabilitation protocol in hospitalized adolescents with restrictive eating disorders. J Adolesc Health 2013;53:585-9.
  • [26] Chang YC, Thew M, Hettich K, Nugent M, Simpson P, et al. Adolescent Inpatients With Eating Disorders: Comparison Between Acute and Chronic Malnutrition States on a Refeeding Protocol. Glob Pediatr Health 2019;6:2333794X19839780.
  • [27] Rizzo SM, Douglas JW, Lawrence JC. Enteral Nutrition via Nasogastric Tube for Refeeding Patients With Anorexia Nervosa: A Systematic Review. Nutr Clin Pract 2019;34:359-70.
  • [28] Leitner M, Burstein B, Agostino H. Prophylactic Phosphate Supplementation for the Inpatient Treatment of Restrictive Eating Disorders. J Adolesc Health 2016;58:616-20.
  • [29] Schwartz BI, Mansbach JM, Marion JG, Katzman DK, Forman SF. Variations in admission practices for adolescents with anorexia nervosa: a North American sample. J Adolesc Health 2008;43:425-31.
  • [30] Gentile MG, Pastorelli P, Ciceri R, Manna GM, Collimedaglia S. Specialized refeeding treatment for anorexia nervosa patients suffering from extreme undernutrition. Clin Nutr 2010;29:627-32.
Year 2020, Volume: 14 Issue: 2, 136 - 142, 18.03.2020
https://doi.org/10.12956/tchd.598217

Abstract

References

  • [1] Kraft MD, Btaiche IF, Sacks GS. Review of the refeeding syndrome. Nutr Clin Pract 2005;20:625-33.
  • [2] Academy of Eating Disorders. Academy for Eating Disorders Report 2016, 3rd Edition: Eating Disorders, A Guide to Medical Care. Erişim tarihi: 25 July 2019. Available from: https://www.aedweb.org/resources/publications/medical-care-standards
  • [3] Bargiacchi A, Clarke J, Paulsen A, Leger J. Refeeding in anorexia nervosa. Eur J Pediatr 2019;178:413-22.
  • [4] Sachs K, Andersen D, Sommer J, Winkelman A, Mehler PS. Avoiding medical complications during the refeeding of patients with anorexia nervosa. Eat Disord 2015;23:411-21.
  • [5] Garber AK, Sawyer SM, Golden NH, Guarda AS, Katzman DK, et al. A systematic review of approaches to refeeding in patients with anorexia nervosa. Int J Eat Disord 2016;49:293-310.
  • [6] Whitelaw M, Gilbertson H, Lam PY, Sawyer SM. Does aggressive refeeding in hospitalized adolescents with anorexia nervosa result in increased hypophosphatemia? J Adolesc Health 2010;46:577-82.
  • [7] Norris ML, Spettigue WJ, Katzman DK. Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatr Dis Treat 2016;12:213-8.
  • [8] Redgrave GW, Coughlin JW, Schreyer CC, Martin LM, Leonpacher AK, et al. Refeeding and weight restoration outcomes in anorexia nervosa: Challenging current guidelines. Int J Eat Disord 2015;48:866-73.
  • [9] Center for Disease Control and Prevention. CDC Growth Charts: Z-score data files. Erişim tarihi: 27 Temmuz 2019. Available from: https://www.cdc.gov/growthcharts/zscore.htm
  • [10] Becker PJ, Nieman Carney L, Corkins MR, Monczka J, Smith E, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). J Acad Nutr Diet 2014;114:1988-2000.
  • [11] Sociery for Adolescent Health and Medicine. Refeeding hypophosphatemia in hospitalized adolescents with anorexia nervosa: a position statement of the Society for Adolescent Health and Medicine. J Adolesc Health 2014;55:455-7.
  • [12] Ornstein RM, Golden NH, Jacobson MS, Shenker IR. Hypophosphatemia during nutritional rehabilitation in anorexia nervosa: implications for refeeding and monitoring. J Adolesc Health 2003;32:83-8.
  • [13] Clark CL, Sacks GS, Dickerson RN, Kudsk KA, Brown RO. Treatment of hypophosphatemia in patients receiving specialized nutrition support using a graduated dosing scheme: results from a prospective clinical trial. Crit Care Med 1995;23:1504-11.
  • [14] Golden NH, Katzman DK, Sawyer SM, Ornstein RM, Rome ES, et al. Position Paper of the Society for Adolescent Health and Medicine: medical management of restrictive eating disorders in adolescents and young adults. J Adolesc Health 2015;56:121-5.
  • [15] Akgül S, Pehlivantürk-Kızılkan M, Örs S, Derman O, Düzçeker Y, et al. Type of setting for the inpatient adolescent with an eating disorder: Are specialized inpatient clinics a must or will the pediatric ward do? Turk J Pediatr 2016;58:641-9.
  • [16] Cuerda C, Vasiloglou MF, Arhip L. Nutritional Management and Outcomes in Malnourished Medical Inpatients: Anorexia Nervosa. J Clin Med 2019;8.
  • [17] Smith K, Lesser J, Brandenburg B, Lesser A, Cici J, et al. Outcomes of an inpatient refeeding protocol in youth with Anorexia Nervosa and atypical Anorexia Nervosa at Children's Hospitals and Clinics of Minnesota. J Eat Disord 2016;4:35.
  • [18] O'Connor G, Nicholls D. Refeeding hypophosphatemia in adolescents with anorexia nervosa: a systematic review. Nutr Clin Pract 2013;28:358-64.
  • [19] Brown CA, Sabel AL, Gaudiani JL, Mehler PS. Predictors of hypophosphatemia during refeeding of patients with severe anorexia nervosa. Int J Eat Disord 2015;48:898-904.
  • [20] Kameoka N, Iga J, Tamaru M, Tominaga T, Kubo H, et al. Risk factors for refeeding hypophosphatemia in Japanese inpatients with anorexia nervosa. Int J Eat Disord 2016;49:402-6.
  • [21] Golden NH, Katzman DK, Sawyer SM, Ornstein RM, Rome ES, et al. Update on the medical management of eating disorders in adolescents. J Adolesc Health 2015;56:370-5.
  • [22] Kohn MR, Madden S, Clarke SD. Refeeding in anorexia nervosa: increased safety and efficiency through understanding the pathophysiology of protein calorie malnutrition. Curr Opin Pediatr 2011;23:390-4.
  • [23] Garber AK, Michihata N, Hetnal K, Shafer MA, Moscicki AB. A prospective examination of weight gain in hospitalized adolescents with anorexia nervosa on a recommended refeeding protocol. J Adolesc Health 2012;50:24-9.
  • [24] Garber AK, Mauldin K, Michihata N, Buckelew SM, Shafer MA, et al. Higher calorie diets increase rate of weight gain and shorten hospital stay in hospitalized adolescents with anorexia nervosa. J Adolesc Health 2013;53:579-84.
  • [25] Leclerc A, Turrini T, Sherwood K, Katzman DK. Evaluation of a nutrition rehabilitation protocol in hospitalized adolescents with restrictive eating disorders. J Adolesc Health 2013;53:585-9.
  • [26] Chang YC, Thew M, Hettich K, Nugent M, Simpson P, et al. Adolescent Inpatients With Eating Disorders: Comparison Between Acute and Chronic Malnutrition States on a Refeeding Protocol. Glob Pediatr Health 2019;6:2333794X19839780.
  • [27] Rizzo SM, Douglas JW, Lawrence JC. Enteral Nutrition via Nasogastric Tube for Refeeding Patients With Anorexia Nervosa: A Systematic Review. Nutr Clin Pract 2019;34:359-70.
  • [28] Leitner M, Burstein B, Agostino H. Prophylactic Phosphate Supplementation for the Inpatient Treatment of Restrictive Eating Disorders. J Adolesc Health 2016;58:616-20.
  • [29] Schwartz BI, Mansbach JM, Marion JG, Katzman DK, Forman SF. Variations in admission practices for adolescents with anorexia nervosa: a North American sample. J Adolesc Health 2008;43:425-31.
  • [30] Gentile MG, Pastorelli P, Ciceri R, Manna GM, Collimedaglia S. Specialized refeeding treatment for anorexia nervosa patients suffering from extreme undernutrition. Clin Nutr 2010;29:627-32.
There are 30 citations in total.

Details

Primary Language Turkish
Subjects ​Internal Diseases
Journal Section ORIGINAL ARTICLES
Authors

Melis Pehlivantürk Kızılkan 0000-0002-0637-050X

Sinem Akgül This is me 0000-0001-8203-2337

Orhan Derman 0000-0003-4618-1110

Nuray Kanbur 0000-0001-5767-7926

Publication Date March 18, 2020
Submission Date July 29, 2019
Published in Issue Year 2020 Volume: 14 Issue: 2

Cite

Vancouver Pehlivantürk Kızılkan M, Akgül S, Derman O, Kanbur N. Yatırılarak izlenen anoreksiya nervozalı ergenlerde yeniden beslenme döneminde hipofosfatemi gelişme riski. Türkiye Çocuk Hast Derg. 2020;14(2):136-42.


The publication language of Turkish Journal of Pediatric Disease is English.


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