Paeds Cases · adolescent-and-young-adult-medicine
Eating disorders: refeeding and multidisciplinary-care OSCE — risk stratification, refeeding-syndrome prevention and family engagement
Observed structured encounter testing a safe refeeding plan for a malnourished adolescent: risk stratification, micronutrient and electrolyte management, recognition of refeeding syndrome, and family engagement in family-based treatment.
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Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Station A is a newly admitted 14-year-old at 71% median BMI awaiting the start of refeeding, with anxious parents. Station B is the same patient on day two with a falling phosphate, and the candidate must recognise and manage evolving refeeding syndrome.
Station objectives
- Classify refeeding risk and complete the safe-preparation checklist before the first feed. [1]
- Design a refeeding regimen with thiamine and a phosphate–magnesium–potassium monitoring plan, and justify the calorie-start choice from the evidence. [3]
- Recognise and immediately manage evolving refeeding syndrome. [1]
- Engage anxious parents in family-based treatment with a non-blaming, structured frame. [5]
References6ShowHide
- [1]Mehanna HM; Moledina J; Travis J Refeeding syndrome: what it is, and how to prevent and treat it. BMJ, 2008.PMID 18583681
- [2]O'Connor G; Nicholls D Refeeding hypophosphatemia in adolescents with anorexia nervosa: a systematic review. Nutrition in Clinical Practice, 2013.PMID 23459608
- [3]Garber AK; Cheng J; Accurso EC; Adams SH Short-term Outcomes of the Study of Refeeding to Optimize Inpatient Gains for Patients With Anorexia Nervosa: A Multicenter Randomized Clinical Trial. JAMA Pediatrics, 2021.PMID 33074282
- [4]Golden NH; Cheng J; Kapphahn CJ; Buckelew SM Higher-Calorie Refeeding in Anorexia Nervosa: 1-Year Outcomes From a Randomized Controlled Trial. Pediatrics, 2021.PMID 33753542
- [5]Lock J; Le Grange D; Agras WS; Moye A Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Archives of General Psychiatry, 2010.PMID 20921118
- [6]Rosen DS; American Academy of Pediatrics Committee on Adolescence Identification and management of eating disorders in children and adolescents. Pediatrics, 2010.PMID 21115584