Mirror Mila — Anorexia Nervosa & Refeeding Syndrome
BMI 14, bradycardic and 'fine' — feed her slowly, watch the phosphorus crash
Mila arrives at 82 pounds insisting she needs to lose five more, her heart rate sitting at 42. On day three of her carefully planned refeeding, her phosphorus crashes and she becomes short of breath.
Mila sees a fat person in the mirror despite weighing 82 pounds and restricts food intensely while over-exercising. Severe malnutrition causes bradycardia, hypotension, lanugo and amenorrhea. The most dangerous moment is not starvation itself but refeeding — reintroducing calories too fast causes a rapid drop in phosphorus, potassium and magnesium that can trigger cardiac arrest, so nutrition must be reintroduced slowly with electrolytes checked daily.
Read Mirror Mila's full story →The story arc
The setup
Mila has restricted to under 500 calories a day for months and runs for two hours every morning despite fainting spells.
The turn
Her weight is 82 pounds, heart rate 42, blood pressure 84/52, and fine lanugo hair covers her arms.
The crisis
On day three of refeeding, Mila becomes confused and short of breath, and her phosphorus drops to 1.2 mg/dL.
The save
The care team slows the caloric advancement, replaces phosphorus, potassium and magnesium, and monitors cardiac rhythm continuously.
NCLEX study section — Anorexia Nervosa & Refeeding Syndrome
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Mental Health
Take this chapter into practice questions on the same topic.