Anorexia Nervosa Flashcards
AN
Increasing more common And decreasing age at presentation 12.5years is the age of presentation 10:1 F:M Mortality 0.5% annually Great physical impact
AN presentation
Pale thin wan
URine SG water loading Ketones
ECG Sinus bradycardia PR interval
PR low rate and low BP low temp
Iron def uncommon
Low Mg laxative abuse
Liver is mothballed so low albumin production
Hypo phosphate sign of metabolic decompensation
What is the rate of the weight loss
24hours dietary history
Mental history length of time without a period and when the period comes back its a sign of nutritional recovery
Weight controlling behaviors exercise/laxative/less food/diuretics
Psychological presentation
Self harm /suicide risk Distorted Body image Ideal weight Concentration Sleep Family history of mental illness and AN genetic Co morbidity depression / anxious/ OCD
Medical admission for AN
PT<50 BP <80 and temp<35.5
Hearing voices not psychosis often derogatory ‘your fat’
Bloods can be VERY NORMAL despite significant weight loss
Very vulnerable in cold weather go to sleep and die over night
AN are prone to circulatory collapse and sudden death
Cardiac bradycardia QT s
Vascular vagal hyperactive
REFEEDING syndrome sudden death
REFEEDING syndrome in AN
Do continuous NG feeds high in fat and protein DONT do interval feeding Add in Phospate and test daily Avoid hypophosphatemai Aiming for 1kg/week weight gain Maintain BSL and body temp
Malnutrition in AN effects
BRAIN See changes in the PET scans Bone health OSTEOPOROSIS untreated AN see 4-10% bone loss /year LEAN muscle mass Ca++ Phospahte gaining weight Getting your periods back hormones Periods returning sign of wellbeing LIVER toxicity Renal Immunodeficiency
Sudden death in AN
REFEEDING interval Hypophospatemia Hypoglycemic. ( low glycogen stores) sleep is a period of fasting Prolonged QT Hypothermia
AN DD IBD
CRP and ESR
Most vulnerable in AN
Hypothermia
Bradycardia
REFEEDING
First week continuous NG feeding and phospahte daily
2nd week NG feeds at night and interval feeds
3rd week ?? Remove the NG tube
Bone care in AN
Bone care is one of the cornerstones of AN care
Anabolic strategies Weight gain Restoration of periods Ca++ Activity and exercise increase the lean muscle weight
Medical complications of AN
20% mortality by 20years
Significant morbidity
