Eating Disorders Flashcards
What are the risks of rapid weight loss?
- Refeeding syndrome
- Hypoglycaemia
- Infection
- Cardiac Arrhythmia
- Death
What measurement do we use in children (especially those with an ED) instead of BMI?
Weight for height ratio
List 5 out of 10 conditions that can cause weight loss in adolescents.
- Coeliac disease
- T1DM
- Hyperthyroidism
- Malignancy
- Anorexia nervosa
- IBD
- Oesophageal problems
- Severe depression/OCD/autism
- Juvenile arthritis
- Addison’s disease
What tests would you consider for a child with rapid weight-loss?
- ECG
- U&E
- Phosphate
- Calcium
- Magnesium
- LFTs
- CRP/ESR
- WCC
- TFTs
- TTG
Who is at risk of refeeding syndrome?
It occurs in individuals who have been in a severe nutritional deficit for an extended period, when they start to eat again. Those with;
- BMI <20 who have had little to eat for 5 days
The lower the BMI, the longer the period of malnutrition - the higher the risk of refeeding syndrome
What is refeeding syndrome?
Metabolism in the cells and organs dramatically slows during prolonged periods of malnutrition. When the starved cells process glucose, protein and fats again, they use up magnesium, potassium and phosphorus leading to;
- Hypomagnesaemia
- Hypokalaemia
- Hypoposphataemia
What does refeeding syndrome put the individual at risk of?
Cardiac arrhythmia
Heart Failure
Fluid overload
What is lanugo hair?
Fine hair growth that appears as a response to the loss of insulating fat tissue
How do we manage patients with anorexia nervosa in the short term?
- We physically stabilise the patient - provide appropriate medication
- Aim for 0.5-1kg weight gain weekly
- Monitor bloods (particularly phosphate)
What is a worrying weight for height ratio?
<75%
What do we give to anorexia nervosa patients with a weight for height ratio of <75%?
- Thiamine (Vitamin B1)
- Vitamin B complex
- Multivitamins
Why is hypophosphataemia so worrying in patients with Anorexia Nervosa?
This is a sign of refeeding syndrome
What is the aetiology of anorexia nervosa?
It is a neuro-biological illness. It is NOT the patient’s fault.
What percentage of patients with anorexia nervosa are female?
> 90%
What factors increase the risk of an individual developing anorexia nervosa?
- Genetics; very strong risk factor
- Events around puberty
- Cultural promotion of thinness
What are the 3 main types of ED in younger people?
- Anorexia Nervosa
- Bulimia Nervosa
- EDNOS (eating disorder not otherwise specified)
What are the behavioural/psychological features of anorexia nervosa?
- Pre-occupation with food
- Feeling fat
- Unhappy with body shape
- Won’t eat in front of others
- Hiding food
- Compulsive exerciser
List 6 out of 13 clinical features of anorexia nervosa.
- Low weight for height
- Amenorrhoea
- Headaches
- Cool Peripheries
- Constipation
- Dry skin
- Hair loss
- Fainting/dizziness
- Lethargy/tiredness
- Bradycardia
- Peripheral oedema
- Hypotension
- Hypothermia
What are the 2 common co-morbidities associated with anorexia nervosa?
- OCD
- Depression
What are the features of bulimia nervosa?
- Binge eating
- Low self-worth
- Vomiting
- Often associated with DSH
- Often normal weight
- Poor dentition (recurrent vomiting)
- Glucose intolerance
What sort of therapy can be offered to patients with eating disorders?
CBT
