Use of Total Parenteral Nutrition in Severe Anorexia Nervosa Complicated by a Gastrointestinal Illness

At present there is no consensus on how to refeed patients with severe anorexia nervosa. Staged progressive oral feeding programs, enteral feedings and total parenteral nutrition have been utilized to facilitate recovery. Although most patients with anorexia nervosa should be refed with a dietary program which is based on progressive increases in oral calories, total parenteral nutrition should be judiciously considered for the select patient with severe anorexia nervosa who also has medical comorbidities which preclude the usage of this standard approach. This alternative mode of refeeding may afford a meaningful recovery to a subset of patients with anorexia nervosa for whom the overall prognosis is guarded. However, the usage of total parenteral nutrition in this population is fraught with multiple potential complications which must be averted. Herein is described two patients with severe anorexia nervosa, and comorbid gastrointestinal issues which necessitated a trial of total parenteral nutrition to effectuate weight restoration.