Anorexia Nervosa

Question 1

Anorexia nervosa diagnostic criteria:

Answer 1

Restriction of energy intake relative to requirements
Significantly low body weight
Intense fear of gaining weight
Persistent behaviours to interfere with weight gain
Disturbance in how weight/body shape is experienced
Undue influence of weight/shape on self-evaluation

Question 2

Complications of anorexia nervosa:

Answer 2

Bone marrow suppression: (low Hb, low neuts, low plts)
Psych: suicide, DSH
Neuro: peripheral neuropathies
CVS: Bradycardia, hypotension, pericardial effusion, mitral valve prolapse, sudden cardiac death
Immunosuppression
Cold poor temp regulation
Nutritional: vitamin and electrolyte deficiencies, hypoglycaemia, osteoporosis
Hormonal: amenorrhea

Appearance: lanugo, poor dentition, hair loss, pressure areas

Gas: METABOLIC ALKALOSIS (H+ loss vomiting AND HypoK), hypo-everything
ECG: Bradycardia, heart block, STD/ TWI, long QT, arrhythmia

Question 3

Admission criteria in anorexia nervosa:

Answer 3

BMI <12
PR <50, >120 (or postural increase 30)
SBP <80 (or postural drop 20)
Temp <35.5

Arrhythmia or QT prolonged

BSL <3
K <3
Alb <30
Na <125

Transaminitis
Neuts <0.7

Question 4

Management of anorexia presentation:

Answer 4

?admission criteria met

Warm
Telemetry +/-

CHECK A BSL
+ FBC, UEC, LFT, CMP, gas, B12/folate/zinc/VitD

Thiamine 300mg IV
Multivitamin
Correct electrolytes

?DOC

Question 5

Refeeding syndrome:

Answer 5

When nutrition (any route) supplied to severely malnourished patient.
(Prolonged NBM, malabsorption, eating disorder, starvation, alcoholism)

Carbs/insulin —> insulin and anabolism —> MASSIVE AND DANGEROUS DROP IN PHOSPHATE

Weakness to the point on resp failure
Neurological: ataxia, delirium, coma, pontine myelinosis, encephalopathy…
Arrhythmia
Etc.

ICU
Slow replacement all micronutrients/ electrolytes
Slow fluid