Psychiatr. pro Praxi, 2002; 4: 146-151

Riziko refeeding syndromu u mentální anorexie

MUDr. Miroslava Navrátilová
JIP psychiatrické kliniky, Poradna pro poruchy metabolizmu a výživy FN Brno

Keywords: refeeding syndrome, hypophosphoraemia, glycide energy, mineral dysbalance, intracelular cations, severe malnutrition, nutrition support.

Published: December 31, 2002  Show citation

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Navrátilová M. Riziko refeeding syndromu u mentální anorexie. Psychiatr. praxi. 2002;3(4):146-151.

V článku je zmíněno riziko tzv. refeeding syndromu u nemocných s těžkou formou mentální anorexie. Kazuisticky je v článku popsán případ nemocné, u které došlo k rozvoji těžké hypofosforemie v souvislosti s enterální výživou, přičemž tato hypofosforemie hrozila nutností zahájení arteficiální ventilace. Při biochemické analýze bylo zjištěno, že hypofosforemie souvisela se zahájením nutriční podpory.

V další části je uvedena studie, v níž byly sledovány hladiny elektrolytů a jejich odpad u nemocných s mentální anorexií a u kontrolních osob. Z práce vyplývá, že nemocné s těžkou formou mentální anorexie vyžadující nutriční podporu mají nízký odpad chloridů, sodíku a fosfátu a nízkou sérovou hladinu fosfátu, hořčíku a draslíku. Uvedený obraz tedy předpovídá riziko vzniku refeeding syndromu a vznik možných komplikací (parestezie, svalová paralýza, maligní arytmie, porucha dýchání) po zahájení nutriční podpory. V poslední části článku je uvedena metoda hrazení elektrolytů u nemocných s těžkou formou mentální anorexie a známkami jejich těžkého deficitu v organizmu.

The Risk of the Refeeding Syndrome in Mental Anorexia

This article deals with the risk of th so-called, refeeding syndrome, in patients with the serious form of mental anorexia. The author describes the patient-s state, where a serious hypophosphoraemia stands in connection with enteral nutrition intake and the adverse effects due to artificial ventilation. By biochemical analysis it was found that hypophosphoraemia is connected with continous nutritional support.

The second part presents a study where the electrolyte levels and their decrease in patients with mental anorexia and at the same time in a control group was followed. Upon the conclusion of the named study the patients suffering from the serious form of mental anorexia, where nutritional support was undertaken, had a low loss of chloride, sodium and phosphate and a low serum level of phosphate, magnesium and calcium. From these results can be predicted a risk of the refeeding syndrome occurring and the possibility of complications (paraesthesia, muscle paralysis, malignant arrythmia, breathing disorders) after nutritional support proceeds. The last part of the article presents a method for electrolyte substitution in patients suffering from the serious form of mental anorexia and with the signs of severe deficiency.

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