Anorexia management Flashcards
1
Q
How should anorexia be managed in primary care?
A
- Refer immediately to an age-appropriate eating disorder service
- DO NOT do watchful waiting
- Arrange regular review (weekly) while awaiting service assessment
2
Q
When should an emergency admission be considered in an individual with anorexia nervosa?
A
- BMI/body weight below a safe range (degree of dietary restriction and rate of weight loss, i.e. >1kg per week)
- Cardiovascular instability (bradycardia, <40 bpm, tachycardia on standing, prolonged QT, hypotension)
- Hypothermia
- Reduced muscle power
- Concurrent infection
- Ill-health or rapid deterioration
- Electrolyte imbalance or hypoglycaemia
- Risk of refeeding syndrome
- Acute mental health crisis
- Lack of support at home
3
Q
What psychotherapy is available for anorexia?
A
- CBT-ED
- MANTRA (Maudsley Anorexia Nervosa Treatment for Adults)
- SSCM (Specialist Supportive Clinical Management)
- FPT (Focal Psychodynamic Therapy)
4
Q
What are high-risk risk factors for refeeding syndrome?
A
- BMI <16
- Weight loss >15% within the last 3-6 months
- Little or no nutritional intake for >10 days
- Low levels of potassium, phosphate, or magnesium prior to feeding
5
Q
What are moderate-risk risk factors for refeeding syndrome?
A
- BMI <18.5
- Weight loss of >10% within last 3-6 months
- Little or no nutritional intake for >5 days
- History of alcohol abuse or drugs (inc insulin, chemotherapy, antacids, diuretics)
6
Q
Describe the management of refeeding syndrome.
A
- Start with lower calorie intake and increase over 10 days
- Prescribe thiamine, vitamin B compound strong, and a multivitamin
- Consider daily bloods and ECGs for first 10 days
7
Q
What physiological abnormalities are found in anorexia nervosa?
A
- Hypokalaemia
- Low FSH, LH, oestrogens, testosterone
- Raised cortisol and growth hormone
- Impaired glucose tolerance
- Hypercholesterolaemia
- Hypercarotinaemia
- Low T3
