Eating Disorder - 2 Flashcards
Cardiac Medical Emergencies in Eating disorders (mnemonic)
- HArT POBD
Cardiac Medical Emergencies in Eating disorders (mnemonic)
- HArT POBD
Hypotension
Arrhythmia
Tachycardia, ventricular
Prolonged QT interval
Oedema, peripheral
Bradycardia
Death
Skeletal Medical Emergecy in Eating disorder
osteoporesis
Haematological medical emergencies in eating disorders
Anemia
Leukopenia
Thrombocytopenia
Reproductive Medical emergencies in eating disorders
Amenorhae
Premature Birth
Low LH & FSH
GIT Medical emergencies in eating disorders
Constipation
Delayed emptying
Pancreatitis
Dermatological Medical emergencies in eating disorders
- Lanugo (picture)
- hypercarotenemia
Items on assessment risk checklist?
- Weight Loss & BMI & Weight
-Heart Rate & Cardiovascular Health & ECG
-Hydration & Temperature
-Muscular function
-Biochemical abnormality & haematology
-Disordered eating behaviours
Muscular Function in risk assessment in eating disorders
SUSS test
Hand Grip strength
MUAC
Levels of risk in risk assessments of eating disorders
RED: impending risk to life
Amber: High concern for impending…
Green: low impending risk
RISK Assessment (eating disorder) RED [amber]: impending risk to life for weight loss on
Rapid loss ≥1kg for 2 consec. weeks [amber: .5-1kg/week]
RISK Assessment (eating disorder) RED [amber]: impending risk to life for BMI
Under 18
BMI<70% [amber:70-80%]
Above 18
BMI<13 [amber: 13-14.9]
RISK Assessment (eating disorder) RED [amber]: impending risk to life for Heart Rate
40 [amber: 40-50]
RISK Assessment (eating disorder) RED [amber]: impending risk to life for dehydration
Fluid refusal [amber: fluid restrictio]
no skin turgor [amber:normal skin turgor]
severe dehydration signs [amber: moderate dehydration]
RISK Assessment (eating disorder) RED [amber]: impending risk to life for suss test
unable to seat up from lying flat or squat at all, score 0 or 1 [amber: able to seat up but with difficulty, score 2)
RISK Assessment (eating disorder) RED [amber]: impending risk to life for MUAC
(Mid-Upper-Arm-Circumference)
<18 cm [amber: 18-20 cm]
RISK Assessment (eating disorder) RED [amber]: impending risk to life for Hand grip strenght
Male : <30.5 kg, 3rd percentile[amber: <38 kg 5th percentile]
Female: <17.5 kg [amber: <23 kg}
RISK Assessment (eating disorder) RED [amber]: impending risk to life for ECG abnormality
<18 years QTC
>460 females [amber:>460]
450 males [amber: 450]
>18 years QTC
>450 females [amber the same]
430 males
Any other ECT abnormality [amber: no other abnormality]
what is suss test?
look for muscle wasting and assess muscle strength: Scores of 2 or less (especially if scores are falling) on the Sit up–Squat–Stand (SUSS) test are a red flag.
The sit up test — the person lies flat on a firm surface such as the floor and has to sit up without, if possible, using their hands
RISK Assessment (eating disorder) RED : impending risk to life for Biochemical abnormality
Hypo-
phosphataemia
kalemia (<2.5 mmol/L)
albuminaemia
glycemia
natraemia
calcaemia (<3mmol/L)
Transaminases x3 times normal rage
diabetes mellitus HbA1C>10
RISK Assessment (eating disorder) RED : impending risk to life for HAEMATOLOGY
LOW WHITE CELL COUNT
HAEMOGLOBIN <10G/L
RISK Assessment (eating disorder) RED : impending risk to life for DISORDERED EATING BEHAVIOURS
ACUTE FOOD REFUSAL OR ESTIMATED CALORIE INTAKE <500 CALORIES FOR 2+ DAY
RISK Assessment (eating disorder) RED [amber]: impending risk to life for Temperature
<35.c tympanic 35 axilllary [ amber: <36 celcius]
suss scoring
0 unable to stand up
1 with hand
2 with difficulty
3 no problemo
NICE guidelines
Adults with anorexia nervosa
either one of
1- individual eating disorder-focused CBT (CBT-ED)
2- Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
3- Specialist Supportive clinical management (SSCM)
NICE guidelines
what if CBT-ED,SSCM, MANTRA did not work?
Eating-disorder-focused focal psychodynamic therapy (FPT)
NICE guidelines
for children and young (0-18) with AN
Anorexia-Nervosa-Focused family therapy (FT-AN)
NICE guidelines
for children and young (0-18) with AN
If FT-AN is unsuitable
consider CBT-ED & AFP-AN (adolescent focused psychotherapy)
can medication be offered as sole treatment for anorexia nervosa
Nope!
NICE guidelines
For adults with bulimia nervosa
First step: offer guided self-help programmes
NICE guidelines
For adults with bulimia nervosa
if guided self-help programmes was not suitable or helpful for 4 weeks
CBT-ED
NICE guidelines
For children with bulimia nervosa
First step: Anorexia-Nervosa-Focused family therapy (FT-AN)
if FT-AN is not suitable or working
consider CBT-ED
can medication be offered as sole treatment for Bulimia Nervousa
Nope!!! again
NICE guidelines
For adults with BED
First step: guided self-help programme
NICE guidelines
For adults with BED
if guided self-help programme was not suitable or helpful
CBT-ED
NICE guidelines
For young children with BED
same as adult
can medication be offered as sole treatment for Bulimia Nervousa
Nope nope nope no medication offered as sole treatment
what will patient with purging (vomitting) be advised to do after vomitting?
- Don’t brush teeth
-Don’t eat acidic food and drinks
-Wash mouth with non-acidic mouth wash
what will patient who use laxatives and diuretics be advised about?
diuretics and laxatives do not reduce calorie absorption and weight loss
What is refeeding syndrome?
Refeeding syndrome occurs when a malnourished person resumes feeding. Rapid reintroduction of food may lead to severe complications.
why refeeding syndrome happens?
- rapid shift electrolytes back into cells which they had been leached out during starvation
what electrolyte is involved with refeeding syndrome?
phosphate <2.5 mmol/L
potassium <0.32 mmol/L
magnesium <0.5 mmol/L
what are concequenses of refeeding syndrome?
cardiovascular and neurological complications
onset of refeeding syndrome
within 72 hours of beginning refeeding (1-5 days)
Most serious complication in refeeding syndrome?
cardiac
Features of refeeding syndrome
Low electrolytes
peripheral oedema
disturbance to respiration, cardiac liver transaminases, pulmonary oedema
Risk for refeeding sydnrome
- BMI<13
- Little/no intake >4 days
-Low electrolytes
-Low white blood cell(<3.8) - Low thiamine
-Medical comorbidities
can physical therapy be offered to eating disorders?
No (no yoga, no TMS, no acupuncture or no weight trainings…)
When should bone mineral density scan be done in children and young people
1 year of underweight
if they have bone pain or recurrent fractures
When should bone mineral density scan be done in adults
2 years
when should bone mineral density scan indicated?
if they have bone pain or recurrent fractures
Is oestronge therapy routinely (oral or transdermal) recommended to treat low bone mineral desity in children and yougn people with AN?
no
Rx for women >18 with AN, long-term low body weight and low bone density
Biphosphonates
Biphosphonates indications
women >18 with AN,
long-term low body weight
low bone density
Pharma Rx for young women 13-17 with delayed puberty, long-term low eight and low bone desity
Incremental physiological doses oestrogen
Incremental physiological doses oestrogen indication
Pharma Rx for women 13-17 with delayed puberty, long-term low eight and low bone desity (bone age >15)
Pharma Rx for young women 13-17 with long-term low eight and low bone desity (bone age over 15)
Transdermal 17-B- estradiol (with cyclic progesterone)
