The Underfeeding Syndrome occurs when a patient with severe anorexia nervosa undergoes refeeding that is done too cautiously. It often occurs because the clinician is afraid of complications associated with the refeeding syndrome. Failure to adequately feed the patient can be fatal.
The amount and rate of refeeding should be determined by a dietician familiar with anorexia nervosa. Adequate feeding should result in weight gain within 5-7 days of starting to refeed. Further weight gain should be expected when there is adequate intake.
When to be consider the underfeeding syndrome:
(1) severe neutropenia (Ibrahim et al)
(2) failure to gain weight
(3) low caloric intake that is not increased
To avoid the underfeeding syndrome:
(1) monitor the patient frequently (electrolytes at least every 12 hours)
(2) increase caloric intake as soon as safe (while avoiding overfeeding)
(3) if the patient is unable to comply with an oral meal plan then initiate nasogastric feeding within 24 hours of admission
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