G336(P) Inpatient management of medically unstable restrictive eating disorders

Aims Serious short and long term complications as well as a significant mortality risk result from the prolonged semi starvation associated with restrictive eating disorders unless prompt and early medical treatment and refeeding are provided. To audit and evaluate the initial medical assessment and the treatment and monitoring of children and adolescents admitted with a medically unstable restrictive eating disorder to a tertiary paediatric centre. Method The medical records, drug charts and growth and measurement charts of 21 admissions to a tertiary paediatric centre between October 2017 and April 2019 were reviewed retrospectively via an online case notes portal. Results Of the 21 admissions to a medical inpatient setting, 18 suffered from Anorexia Nervosa (AN), 2 from Avoidant/Restrictive Food Intake Disorder (ARFID) and one was unspecified. 11 patients (52%) had an admission resting heart rate ≤50 bpm with 4 ≤40 bpm. By the time of discharge all patients had a heart rate > 50 bpm. Mean Body Mass Index (BMI) on admission was 15.7 (79.2% of median for age and sex). At discharge this had risen by 0.7 to 16.4 (82.7% of median). 8 patients (38%) had postural cardiovascular instability on admission but none were unstable by the time of discharge. In 12 patients (58%) the graduated meal plan system combined with our Unit’s standard oral phosphate and vitamin supplements were sufficient, but 9 (42.8%) patients required supplementary nasogastric feeds (range 1–43 days) and 6 (28.5%) required oral potassium supplementation. 2 patients required sectioning under the mental health act to enable adequate refeeding. Clinically significant refeeding syndrome was avoided with this treatment regime. There were no deaths. Conclusion With prompt, effective nutritional intervention and careful medical monitoring in children and adolescents with medically unstable restrictive eating disorders, it is possible to reverse potentially fatal short term complications and improve clinical parameters. Other studies have shown that early and effective nutritional intervention may also improve long term outcome.