Patient selection: severe anorexia nervosa
Personnel requirements:
(1) caregivers who have been adequately trained
(2) access to dieticians experienced in the refeeding syndrome
(3) psychiatric support to address the behavioral problems
(4) medical specialists for management of sepsis or other comorbid conditions
Ideally care should be delivered in a specialized eating disorder unit (SEDU).
Operational requirements:
(1) recognition and prevention of sabotaging behaviors
(2) ability to frequently monitor electrolytes and other laboratory measures
(3) avoidance of over- or underfeeding
(4) frequent monitoring to detect early signs of the refeeding syndrome
(5) a clear clinical plan
(6) transparency about care with patient, family and friends
(7) willingness to use legal framework to enforce refeeding when required
