Eating disorders

Question 1

What are the ICD-10 criteria for a diagnosis of anorexia?

Answer 1

Refusal to maintain / achieve normal body weight (BMI <17.5)
Intense fear of gaining weight
Body shape disturbance
Undue influence weight / shape on self-evaluation
Amenorrhoea

Question 2

What are the ICD-10 criteria for a diagnosis of bulimia nervosa?

Answer 2

Binging
Craving (persistent preoccupation with eating)
Compensatory behaviours (to avoid consequences of overeating)
Self-perception of being too fat + intrusive dread of fatness (> being underweight)

Question 3

What is the pathophysiology of Refeeding syndrome?

Answer 3

Very low weight, malnourished >
High carbohydrate (most risky), refeeding > ^ glucose
Sudden ^ of insulin > regeneration of tissues (requires phosphate) > ^ cotransport of phosphate into cells >
decrease in serum phosphate / K / Mg > hypomagnesaemia

Question 4

What is the management of Bulimia nervosa?

Answer 4

Referral to specialist care
20 sessions of CBT-ED
FT-BN (children)
high-dose fluoxetine (LT data lacking)

Question 5

What is the management for anorexia nervosa?

Answer 5

individual eating disorder focussed CBT (CBT-ED)
Maudsley anorexia nervosa treatment for adults (MANTRA)
specialist supporting clinical management (SSCM)

Question 6

What are the physiological abnormalities associated with anorexia nervosa?

Answer 6

Most are low:
hypokalaemia
low FSH, LH, oestrogens, testosterone
impaired glucose tolerance
low T3
Gs and Cs are raised: growth hormone, glucose, cortisol, salivary Glands, cholesterol, carotinaemia

Question 7

What are the potential complications of bulimia nervosa?

Answer 7

Hypokalaemia > palpitations
Acidosis

Question 8

What are the potential complications of anorexia nervosa?

Answer 8

depleted glutathione stores > increased risk of liver injury (paracetamol)