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Zur Qualitätssicherung der Gewichtsrestitution bei Magersucht – Pathophysiologie, evidenzbasierte Praxis und Vermeidung des Refeeding-Syndroms

Quality management in weight restitution in Anorexia nervosa - pathophysiology, evidence-based practice and prevention of the refeeding syndrome

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Zusammenfassung

Beim Refeeding-Syndrom – einer gefürchteten Komplikation bei der Reetablierung von Nahrungsaufnahme von PatientInnen mit Magersucht – kommt es bei mangelernährten PatientInnen zu einer Verschiebung von Elektrolyten und freier Flüssigkeit und damit zu – potenziell tödlichen – kardiovaskulären, respiratorischen und neurologischen Symptomen. Ursache dieser Veränderungen sind metabolische und hormonelle Prozesse während der Wiederaufnahme kohlenhydratreicher Ernährung. Als Ausdruck dieser Prozesse kommt es am häufigsten primär zu einer Hypophosphatämie, welche jedoch von anderen laborchemischen Abnormitäten begleitet werden kann.

Aktuell existieren noch keine einheitlichen Guidelines zur Vorbeugung und Management des Refeeding-Syndroms. Unterschiedliche nieder- als auch hochkalorische Ernährungsprotokolle führten in Fall- und Kohortenstudien zu vergleichbaren Ergebnissen bei ähnlichen Komplikationsraten. Ein Fokus sollte auf die Prävention durch ein engmaschiges und frühzeitiges Monitoring gelegt werden. Die Pathophysiologie, die wichtigsten Konstituenten bei der Entstehung des Refeeding-Syndroms, Empfehlungen zur Risikoeinschätzung und Behandlung, sowie die derzeitige Evidenz sollen hier besprochen werden.

Summary

During refeeding syndrome—a well-known and dreaded complication of weight-restauration in anorexia nervosa—a shift of electrolytes and fluid can occur in malnourished patients and might therefore lead to—potentially fatal—cardiovascular, respiratory and neurological symptoms. Causes of this are metabolic and hormonal changes during re-establishment of a carbohydrate-rich diet. This syndrome is most commonly associated with hypophosphatemia, which can however be accompanied by other chemical laboratory abnormalities.

Standardized guidelines for the prevention and management of the refeeding syndrome have not yet been established. In case and cohort studies different low- and high-calorie diet protocols led to comparable results with similar complication rates. A focus should be placed on prevention of serious complications by careful monitoring. The pathophysiology, the main constituents in the development of the refeeding syndrome, recommendations for risk assessment and treatment, and current evidence are discussed.

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Authors and Affiliations

  1. Eating Disorders Unit, Universitätsklinik für Kinder- und Jugendpsychiatrie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich

    Michael Mayr, Katrin Skala &  Andreas Karwautz

  2. Kompetenzzentrum für Essstörungen und Adipositas, Parklandklinik, Bad Wildungen, Deutschland

    Hartmut Imgart

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  1. Michael Mayr
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Correspondence to Michael Mayr or Andreas Karwautz.

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Mayr, M., Imgart, H., Skala, K. et al. Zur Qualitätssicherung der Gewichtsrestitution bei Magersucht – Pathophysiologie, evidenzbasierte Praxis und Vermeidung des Refeeding-Syndroms. Neuropsychiatr 29, 200–211 (2015). https://doi.org/10.1007/s40211-015-0165-7

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