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Refeeding Rate in Severe AN — MRCPsych Paper B MCQ

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HardChild & Adolescent PsychiatryRefeeding Rate in Severe ANMRCPsych Paper B

A 15-year-old girl with anorexia nervosa is admitted to an acute paediatric unit for medically supervised refeeding. Her weight is 67% of the median BMI for her age and sex, and she has had little or no nutritional intake for 5 days. Baseline phosphate, potassium and magnesium are within their reference ranges. According to current Royal College of Psychiatrists MEED guidance, which initial refeeding regimen is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Start at 20 kcal/kg/day and increase by 5 kcal/kg every 2 days

Explanation lettering: E = shown as A · C = shown as B · D = shown as C · B = shown as D · A = shown as E

B is correct. She has two MEED high-risk features: weight below 70% median BMI and little or no intake for more than 4 days. MEED recommends starting a high-risk patient at 20 kcal/kg/day and increasing by 5 kcal/kg every 2 days towards approximately 60 kcal/kg/day or more. Phosphate, potassium and magnesium should be monitored every 12–24 hours for the first 5 days, with vitamin and electrolyte supplementation as indicated. Starting at 30–35 kcal/kg/day is the MEED regimen for patients who are not at high risk. Regimens beginning at 1400–2000 kcal/day are supported for most adolescents but not those at the highest risk. The older 5–10 kcal/kg/day formulation risks underfeeding and is not the current MEED recommendation for this scenario.

Reference: Royal College of Psychiatrists. Medical Emergencies in Eating Disorders: Guidance on Recognition and Management (MEED), CR233, 2022, Chapter 4, Tables 6 and 8. https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr233-medical-emergencies-in-eating-disorders-%28meed%29-guidance.pdf?sfvrsn=2d327483_59