Refeeding syndrome in a patient with anorexia nervosa

A 22 year old woman with a one year history of anorexia nervosa was admitted as an emergency after she collapsed. She was hypoglycaemic, with a blood glucose concentration of 1.5 mmol/l. Her hypoglycaemia was corrected, and, after discussion with her and her eating disorder specialist, she was transferred to the gastroenterology unit to start nasogastric refeeding. Her body mass index was 12.9.

During the next 10 days her liver function tests became deranged—alanine transaminase was 546 U/l, and γ glutamyltransferase was 47 U/l. She was subsequently transferred to a specialist eating disorder unit as an inpatient for psychiatric and psychotherapeutic management alongside the continued refeeding programme.