35. Eating disorder (5%) Flashcards
Chez un patient pour lequel vous avez identifié un trouble alimentaire, prenez une anamnèse appropriée, y compris quoi ?
- habitudes alimentaires, relation avec la nourriture, image corporelle, détresse ;
- troubles sous-jacents de santé mentale, y compris traumatisme psychologique antérieur, et les troubles liés à l’usage de substances ;
- usage de médicaments en vente libre et sur ordonnance, de tabac, de caféine, de laxatifs et de suppléments
Chez un patient qui présente un trouble alimentaire,
a) Évaluez les complications physiologiques et métaboliques
b) Déterminez si l’hospitalisation ou une intervention immédiate sont nécessaires
Lorsqu’un diagnostic de trouble alimentaire est posé, quoi faire ? (prise en charge) (5)
- Discutez de l’impact et des conséquences potentielles, peu importe si le patient accepte le diagnostic ou non
- Faites participer les parents, soignants, conjoints dans le traitement lorsque cela est approprié, et avec le consentement du patient
- Collaborez avec le patient et, s’il y a lieu, la famille pour créer un plan de traitement, incluant une orientation vers des ressources interprofessionnelles ou intraprofessionnelles le cas échéant
- Utilisez d’abord une intervention cognitivo-comportementale simple (c.-à-d. ne pas conclure qu’il faut nécessairement des soins tertiaires)
- Réévaluez périodiquement les comportements et leurs impacts sur l’humeur, l’anxiété, la fonction cognitive et les relations avec les proches
Nommez les complications d’un trouble des conduites alimentaires (3)
- arythmie sans cardiopathie
- déséquilibre électrolytique en l’absence de médicament ou d’insuffisance rénale
- aménorrhée en l’absence de grossesse
Name DSM criteria : Anorexia Nervosa
- Restriction of energy intake relative to requirements, leading to a significantly low body weight (BMI<18.5 or <5th percentile in children, or rate of weight loss) in the context of age, sex, developmental trajectory, and physical health.
- Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
- Subtypes : Restricting, Bing-eating/purging type
Name criteria : Bulimia Nervosa (BN)
Describe : Avoidant/Restrictive Food Intake Disorder (ARFID)
Describe investigations : Eating disorder
- EKG Bradycardia, non-specific ST-T wave changes including ST segment depression, U waves in the presence of hypokalemia and hypomagnesemia
- CBC (hemoglobin, leukocytes, platelets)
- Serum electrolytes (Na, K, Glucose, Blood urea nitrogen, Creatinine, Calcium, Magnesium, Phosphate)
- TSH, T4, T3
- Liver function tests (AST, ALT, bilirubin)
- Amylase/lipase
- Albumin, transferrin
- UA
- BhCG r/o pregnancy
- Consider celiac screen
Describe investigations if underweight > 6 months
- Bone densitometry to assess for osteopenia and osteoporosis
- Abdominal ultrasound to assess maturity of ovaries and uterus
- FSH, LH, and estradiol levels in females
- Testosterone levels in males
Whats the weight gain goal of anorexia nervosa ?
90% of expected weight
Gradual weight gain in AN (1lb/week)
Describe pharmacotherapy in eating disorder
- SSRI / Fluoxetine at higher doses (60mg/d) in BN
- Multivitamins with iron and Vitamin D
- Consider Zinc 50mg PO daily (aids in weight gain)
- Treat acne (as patient re-experience puberty as they gain weight)
Name non-negotiable physical and nutritional indicators for hospitalization (8)
- Suicide risk, food refusal
- Vitals unstable
- ECG arrhythmia
- Electrolyte abnormalities
- Acute medical complications of malnutrition
- Comorbid psychiatric or medical (poorly controlled diabetes type 1)
- Pregnancy with an at risk foetus
- Inadequate weight gain, failure of outpatient treatment
Name unstable vital signs needing hospitalisation in eating disorder (3)
- Core temperature < 35.5°C or 95.5°F
- Heart rate < 40 beats per minute or severe bradycardia
- Blood pressure < 90/60 mm Hg or orthostatic hypotension
Name unstable electrolyte abnormalities needing hospitalisation in eating disorder (6)
- Sodium < 127 mmol/l
- Potassium < 2.3 mmol/l
- Hypoglycaemia; blood glucose < 2.5 mmol/l
- Hypophosphataemia; phosphorous below normal on fasting
- Magnesium < 0.6 mmol/l (normal above 0.7 mmol/l)
- Rapid and progressive weight loss
Name : Acute medical complications of malnutrition
- Signs of inadequate cerebral perfusion (confusion, syncope, loss or decreased level of consciousness, organic brain syndrome, ophthalmoplegia, seizure, ataxia)
- Seizure
- Heart failure
- Pancreatitis
- Severe acrocyanosis
- Dehydration that does not reverse within 48 hrs
- Muscular weakness
Describe : Refeeding syndrome
- Metabolic changes during refeeding of a malnourished patient
- Risk of hypophosphatemia leading to heart failure, arrhythmia, respiratory failure
- Prevent with careful slow refeeding/monitoring and phosphate supplementation
