Refeeding syndrome (falling phosphorus, potassium, magnesium; fluid overload) is life-threatening - report and slow nutrition.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client with anorexia nervosa is hospitalized. Which is a priority nursing concern?
Answer: B. Severe malnutrition causes life-threatening electrolyte imbalance and cardiac dysrhythmias; monitor electrolytes/cardiac status and watch for refeeding syndrome when nutrition resumes.
Question 2 of 3
A client with anorexia begins refeeding. The nurse monitors closely for:
Answer: B. Refeeding syndrome causes dangerous shifts — especially hypophosphatemia, hypokalemia, and hypomagnesemia — that can cause cardiac and neuro complications. Advance nutrition slowly and monitor electrolytes.
Question 3 of 3
A client with bulimia nervosa is at risk for which complication from repeated vomiting?
Answer: B. Self-induced vomiting causes electrolyte imbalance (hypokalemia → dysrhythmias), metabolic alkalosis, dental erosion, and esophageal tears. Monitor electrolytes and cardiac status.
Keep the streak going with more questions like these, each with a full rationale.
What is anorexia nervosa?
Self-worth is tied to control over eating. It carries the highest mortality of any psychiatric illness due to cardiac and electrolyte complications, including refeeding syndrome.
Key points to remember
- Clients are significantly underweight yet perceive themselves as overweight (distorted body image).
- Restricting intake, excessive exercise, and sometimes purging maintain low weight.
- Physical signs include amenorrhea, bradycardia, hypotension, hypothermia, lanugo, and electrolyte imbalance.
- Behaviors include rigid rituals, control issues, perfectionism, and food preoccupation.
- Refeeding syndrome with hypophosphatemia can be fatal when nutrition is restarted too quickly.
- Severe starvation causes life-threatening cardiac arrhythmias and bradycardia.
Signs & symptoms
- Distorted body image, fears fat
- Severe restriction, amenorrhea
- Lanugo, bradycardia, cold intol
Nursing priorities
- Monitor vital signs, weight, intake/output, and electrolytes for medical instability.
- Establish a structured eating plan and observe the client during and after meals.
- Prevent purging by supervising for at least one hour after eating.
- Refeed slowly and watch for refeeding syndrome (declining phosphorus, potassium, magnesium).
- Address distorted thinking and self-esteem without focusing solely on food and weight.
Labs & values
Patient teaching
- Restart nutrition gradually under supervision to avoid refeeding complications.
- Recovery focuses on health and coping, not just weight; engage with therapy and support.
- Family-based support and avoiding power struggles over food aid recovery.
Red flags: report now
- Refeeding syndrome (falling phosphorus, potassium, magnesium; fluid overload) is life-threatening - report and slow nutrition.
- Bradycardia, hypotension, and arrhythmias indicate cardiac compromise requiring immediate attention.
- Severe hypokalemia from restriction or purging can trigger fatal dysrhythmias.
- Refusal of food with rapidly worsening vitals may require involuntary medical stabilization.
References
Clinical references for this topic
