Intended for healthcare professionals

Endgames Case report

Refeeding syndrome in a patient with anorexia nervosa

BMJ 2010; 340 doi: (Published 11 February 2010) Cite this as: BMJ 2010;340:c56
  1. Tharaka Gunarathne, specialist trainee in psychiatry,
  2. Rebecca McKay, staff grade gastroenterologist,
  3. Lesley Pillans, speciality doctor, psychiatry,
  4. Alastair Mckinlay, consultant gastroenterologist,
  5. Philip Crockett, consultant psychiatrist in psychotherapy and eating disorders
  1. 1Eden Unit, North of Scotland Inpatient Eating Disorder Unit, Royal Cornhill Hospital, Aberdeen AB25 2ZH
  1. Correspondence to: P Crockett philipcrockett{at}

    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.


    • 1 What classic biochemical and physical complications may occur in refeeding syndrome?

    • 2 What is the most likely cause of the deranged liver function tests?

    • 3 How can refeeding syndrome be prevented?

    • 4 What other important physical risks exist in severe anorexia nervosa?

    • 5 What are the most important elements of the psychiatric management of this disease?


    1 What classic biochemical and physical complications may occur in refeeding syndrome?

    Short answer

    Hypophosphataemia, hypomagnesaemia, gastric dilation, congestive cardiac failure, severe oedema, confusion, coma, and death.

    Long answer

    Refeeding syndrome is chiefly defined as the …

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