Anorexia Nervosa

Use of total parenteral nutrition in the refeeding of selected patients with severe anorexia nervosa

International Journal of Eating Disorders
By Philip S. Mehler, MD, FACP, FAED, CEDS


Objective: At present there is no consensus on how to refeed patients with severe anorexia nervosa. In these case reports, we describe two patients beset with gastrointestinal comorbidities which impaired their ability to refeed with a staged oral feeding program. The use of total parenteral nutrition (TPN) facilitated their recovery.

Method: We present two cases of severe anorexia nervosa, complicated by comorbid gastrointestinal disorders, which precluded them from successful refeeding using oral food calories. The treatment with TPN consisted of using a surgically placed, indwelling tunneled catheter to deliver progressively increased amounts of intravenous calories. This facilitated successful weight restoration.

Conclusion: Although most patients with anorexia nervosa should be refed with a dietary program which is based on progressive increases in oral calories, TPN should be judiciously considered for patients with severe anorexia nervosa who also have medical comorbidities which preclude the usage of this standard approach.

Written by

Philip S. Mehler, MD, FACP, FAED, CEDS

Dr. Philip S. Mehler began his career at Denver Health more than 35 years ago and was formerly its Chief of Internal Medicine and then Denver Health’s Chief Medical Officer (CMO) until he was promoted…

ACUTE Earns Prestigious Center of Excellence Designation from Anthem
In 2018, the ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health was honored by Anthem Health as a Center of Excellence for Medical Treatment of Severe and Extreme Eating Disorders. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. It comes after a rigorous review process.

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