Psychiatrie - Sekce poruchy příjmu potravy

34
Abstrakta
pozitivních vzorů bývalých pacientek, které se
do Klubu přichází podělit o své zážitky ze života
„bez nemoci“.
Naopak pacientky v závěrečné fázi léčby často
zmiňují, jako důležité bylo připomenout si díky
dívkám přicházejícím do Klubu poprvé, jak se
cítily, a jaké potíže měly před zahájením léčby.
Summary: Patients group for eating disorders
is organized by Eating Disorders Unit and Eating
Disorders Day Care Centre since 1992. It is a platform
for meeting and changing information between
inpatients, outpatients and women suffering from
ED which are hesitating to start the treatment. There
they can gain more information and support from
those just undergoing the treatment. This form
seems to be in some cases more effective than
persuasion from their parents, partners or professionals.
Also patients them self often benefit from
being reminded about symptoms and feelings they
had at the beginning of their cure.
Riziko „refeeding syndromu“
u pacientek s anorexia nervosa
The risk of refeeding syndrome in anorexia
nervosa
Navrátilová M., Hamrová M., Tůmová J., Češková
E., Sobotka L.
Department of Psychiatry, Medical Faculty
Masaryk University and Faculty Hospital
Brno, Department of Nutrition Therapy, Masaryk
University Hospital.,Department of
Clinical Biochemistry, Faculty of Medicine,
Masaryk University Hospital, Brno, Department
of Metabolic Care and Gerontology,
Faculty of Medicine, Charles University, Hradec
Králové, Czech Republic
Souhrn: Autorka se zabývá problematikou
“refeeding syndromu” u anorexia nervosa.
Introduction: Refeeding syndrome is a dangerous
consequence of rapid and excessive food
intake in severely malnourished subjects. This
condition occurred in wartime when prisoners of
war were quickly re-nourished after their liberation
and they died suddenly. However, even at
the present time it is a not unusual complication
of artificial nutrition in previously malnourished
patients. Anorexia nervosa patients are especially
prone to develop refeeding syndrome. Refeeding
syndrome can be associated with hypophosphataemia,
hypomagnesaemia, hypokalaemia,
vitamin deficiency and fluid retention.
Involvement of ventilatory muscle function
can cause hypoventilation and eventually respiratory
failure. Rhabdomyolysis has also been described
as result of severe hypophosphataemia.
Phosphate deficiency can also cause thrombocytopaenia,
impaired blood clotting and deficiency
of leukocyte function. Psychological
changes comprise perturbed mental state, confusion
and eventually coma.
The first step in the prevention of refeeding
syndrome development is to anticipate it.
Aim of study: The aim of present study
was to measure plasma electrolytes in a group
VII. Mezioborová konference o poruchách příjmu potravy a obezitě s mezinárodní účastí | 19. – 21. 3. 2009
of patients with anorexia nervosa to presume
which eventual electrolyte deficiency is most
critical for development of refeeding syndrome.
Methods: We studied 52 patients suffering
from Anorexia nervosa.
These patients were asked to collect their
urine and on the following day their plasma
blood samples were withdrawn and electrolyte
concentration were measured in plasma and
urinary samples.
Values were compared with healthy controls
(medical staff).
Results: BMI of Anorexia nervosa (AN)
patients was significantly lower than that of
controls.
Plasma levels of Na, K, Cl, Mg and P were not
significantly different from controls (Fig).
Urinary outputs of Na, K, were not significantly
different from controls.
Urinary output of Mg and P was significantly
lower in AN than in controls.
Conclusion: Plasma electrolyte levels were
within normal limits. However urinary output of
phosphate and magnesium were decreased.
This corresponds to phosphate and magnesium
deficiency in our group of patients with anorexia
nervosa.
It can be concluded from our results that
our patients with anorexia nervosa are at risk
of development of refeeding syndrome due to
phosphate and magnesium deficiency.