student research day - Case Western Reserve University School of ...

Meryl Twarog
Outcomes for Patients with Eating Disorders Using a Standardized
Inpatient Protocol
Meryl Twarog, Ellen Rome, Gina Ramirez, Laura Gillespie, Anne Song, Sarah Worley, Shannon McIntyre, Meredith Lahl,
Christina Detallo, Skyler Kalady
Dept. of General Pediatrics and Adolescent Medicine, Dept. of Quantitative Health Sciences, Dept. of Nursing Education,
Dept. of Nutrition Therapy
Cleveland Clinic and Case Western Reserve University School of Medicine
No prior studies have evaluated the effectiveness of a standardized protocol for inpatient medical treatment of
patients with nutritional insufficiency (NI).
We hypothesize that use of an inpatient protocol at our institution will prevent refeeding syndrome and sudden
cardiac death. A secondary aim of this study was to document time to resolution of medical instabilities including
as bradycardia, orthostasis, hypokalemia and prolonged QTc rhythm.
A retrospective chart review was conducted from patients hospitalized for NI or medical complications of eating
disorders from June 2005 to August 2008. Patients were identified by billing codes (269.9, 263.9). The data
extracted included demographics, medical instabilities at admission, time to resolution of abnormalities, nutritional
status at resolution and complications during refeeding. In addition, we documented change in weight, BMI and
percent MBW during hospitalization for all patients and divided the data by gender for further comparison.
Statistical analysis focused on determining means and medians for continuous variables and calculating percents
for categorical data.
Fifty-two patients were admitted using the NI protocol (8% male, 94% female) with a median age of 17 (range 11
to 23). Mean change in percent MBW from admission to discharge was 3.35% (p value