Watch for Hypophosphatemia in Severely Malnourished Anorectic Patients

Severely malnourished patients with eating disorders may be at risk of developing hypophosphatemia following oral refeeding. Hypophosphatemia, defined as serum phosphorus concentrations <2.5 mg/dl, usually appears as a result of refeeding with total patenteral nutrition, and is much rarer with nasogastric or oral refeeding.

A group at the North Shore University Hospital, Manhasset, NY, advise those who treat severely malnourished patients, either as inpatients or outpatients, to be alert for the development of the refeeding syndrome. It can occur even in patients receiving oral refeeding alone.

The authors reported 3 cases in which hypophosphatemia developed after oral refeeding for anorexia nervosa (Int J Eat Disord 2000;28 (2):181). All 3 patients developed significant hypophosphatemia—a low of 0.9 mg/dl in 2 patients and 1.7 mg/dl in the third. The first patient received up to 3000 kcal/day, along with intravenous fluids in the hospital. The other patients ate large amounts of food at home for several days. The authors treated these patients by overall caloric restriction and added dietary phosphorus, which rapidly brought phosphorus levels back to normal.