Propranolol is Highly Effective to Treat Refeeding Oedema in a Girl with Anorexia Nervosa - A Case Report

Editorial

Ann Nutr Disord & Ther. 2017; 4(1): 1039.

Propranolol is Highly Effective to Treat Refeeding Oedema in a Girl with Anorexia Nervosa - A Case Report

Buchhorn R*, Bauman C and Willaschek C

Caritas Krankenhaus Bad Mergentheim, Department of Pediatrics, Germany

*Corresponding author: Reiner Buchhorn, Caritas Krankenhaus Bad Mergentheim, Department of Pediatrics, Uhlandstr 7, 97980 Bad Mergentheim, Germany

Received: February 14, 2017; Accepted: February 20, 2017; Published: February 22, 2017

Editorial

Edemas occur as a result of reinstitution of nutrition to patients who are severely malnourished due to anorexia nervosa, starvation or severe illness [1]. This refeeding oedema seems to be a part of the so called refeeding syndrome with a significant mortality in highly developed medical systems but most of all in starved children in the developing world [2]. The metabolic disturbances of the refeeding syndrome are well understood and investigated. However cardiac involvement is highly speculative although mortality is related to oedema and sudden cardiac death [3]. Within the last ten years we developed a pathophysiological model based on 24 hours heart rate variability analysis to explain the impact of nutrition on the autonomic nervous system [4]. These data may explain bradycardia in children with anorexia nervosa and the autonomic shift to sympathetic activation during refeeding.

In 1995 we had developed a pathophysiological model to explain the therapeutic effect of propranolol on oedema in children with single ventricle after the Fontan’s procedure. The mechanism involved seems to be an increased mean capillary filtration pressure, calculated from hemodynamic data based on Starling’s theories of ultra filtration in the capillaries [5].

Based upon these two pathophysiological models we recently treat a 14 years old girl with anorexia nervosa who developed leg oedema during refeeding with 1mg/kg propranolol: Anorexia nervosa in this girl was a “complication” of in hospital treatment of obesity with weight reduction of 35kg. During refeeding the girl developed leg oedema that spontaneously resolved in our department using the NICE protocol for refeeding (http://www.eastcheshire. nhs.uk/About-TheTrust/policies/N/Nutrition%20%20Refeeding%20 Syndrome%20Guidelines%20ECT2366.pdf)

However after slowly augmentation of nutrition up to 3500 kcal using 1) high energy liquid nutrition and substitution 2) Vitamin B, Zinc, Potassium, Calcium Glycero phosphate, magnesium and omega-3-fatty acid supplementation, the girl developed severe leg oedema again. We observe no metabolic derangement like hypophosphatemia, hypokalemia and hypomagnesemia but dilution effects like decrease of hematocrit and plasma protein (Table 1). Despite normal ventricular function echocardiography showed little pericardial effusion and the NT-Pro-BNP values increase up to 869pg/ ml indicating elevated atrial filling pressures. In this situation we decide to treat with 0.5mg/kg propranolol uptitrated to 1mg/kg after two days on our intensive care ward. We use the device NutriPlus© (Data Input, Pöcking, Germany) for Bio Impedance Analysis (BIA).

Citation: Buchhorn R, Bauman C and Willaschek C. Propranolol is Highly Effective to Treat Refeeding Oedema in a Girl with Anorexia Nervosa - A Case Report. Ann Nutr Disord & Ther. 2017; 4(1): 1039. ISSN:2381-8891