Anorexia nervosa has the highest mortality of all psychiatric conditions. Sligo University Hospital (SUH) uses the MARSIPAN protocol for the (Management of Really Sick Patients with Anorexia Nervosa) for inpatient treatment.
Case 1; 22-year-old lady with a BMI of 12.06 kg/m2, admitted voluntarily and reported food and bowels dominated her life, did not leave the house, consuming only nutritional supplements, laxatives. She was commenced on a naso-gastric feed at 10/kcal/kg/day, 1 litre fluid restriction, cardiac monitoring, confined to bed (commode for toileting), nursed one-to-one in an observation bay on a general medical ward. Electrolyte supplementation was required for refeeding syndrome. Although weak she displayed significant sabotaging behaviour, micro-exercising in bed, on her phone/computer. She continued to hold bowel and bladder for weighing. She remained in hospital for 63 days with gradual reintroduction of oral diet and exercise. 9 months post discharge she has a BMI 18.5 kgs/m2 and a part-time job.
Case 2; 27 year old lady with 10 Ibs weight loss in 3 weeks eating only celery, BMI 13.0 kgs/m2. The MARSIPAN protocol was commenced as above, allowing only vitamin supplementation orally. However she aspirated, developed pneumonia and respiratory failure requiring and mechanical ventilation and inotropic support and electrolyte supplementation for refeeding syndrome. Upon weaning sedation she commenced micro-exercising with limb movements, animated conversations, requests for opening of windows to shiver and lose calories. She remained in hospital for 83 days. 7 months post discharge she has a BMI of 16 kg/m2 and is living independently.
As one of only 2 Specialist Eating Disorder Units in Ireland a protracted coordinated multidisciplinary approach has been successful in 14 such patients to date.