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This is a case story of a 14-year-old girl with severe anorexia nervosa (AN) (158 cm, 28 kg, –44.1% ideal body mass index), admitted with purpura, edema, and general fatigue. We treated her carefully and paid particular attention to prevent development of refeeding syndrome (RS), and her body weight increased satisfactorily. However, RS (edema, hypoalbuminemia, and heart failure) occurred despite careful treatment. We used albumin and diuretics for treatment of RS, but severe liver damage resulted. RS was aggravated by the medical treatment. More attention should have been paid to her weight gain and medical treatment should have been initiated more slowly to prevent dramatic changes in the patient's fluid and electrolyte status.