Eating disorders

Question 1

Name the 3 classes of eating disorder

Answer 1

anorexia nervosa
bulimia nervosa
OSFED

Question 2

Risk factors for developing an eating disorder

Answer 2

family history
perinatal factors - hypoxic brain injury, poor prenatal and postnatal nutrition
temperament/personality traits - childhood perfectionism, low self esteem, early feeding disturbance

Question 3

Examination findings in patients with an eating disorder

Answer 3

cachexia
lanugo hair
discoloured peripheries
pallor
hair loss
muscle wasting
dry lips + mucous membranes
reduced skin turgor
sunken eyes
bradycardia/tachycardia
postural changes in BP + HR
hypotension
low core body temp
peripheral oedema

Question 4

Differentials for weight loss in adolescents

Answer 4

endocrine - DM, hyperthyroidism, glucocorticoid deficiency

oncology - lymphoma, leukaemia

gastrointestinal - coeliac, IBD

psychiatric - eating disorder, autism, OCD, illicit drugs

Question 5

Investigations in a patient with an eating disorder

Answer 5

baseline bloods:
- FBC
- urea, creatinine + electrolytes
- phosphate
- LFTs inc. albumin
- magnesium
- CRP
- glucose

ECG:
- rate
- QTc interval

Question 6

What could low sodium mean in an eating disorder patient?

Answer 6

water loading
occult chest sepsis with SIADH

Question 7

What could low potassium mean in an eating disorder patient?

Answer 7

consider vomiting/laxative abuse

Question 8

What could low glucose (<3) mean in an eating disorder patient?

Answer 8

occult infection
(especially if low albumin/raised CRP)

Question 9

What could low phosphate mean in an eating disorder patient?

Answer 9

early sign of refeeding syndrome

Question 10

How might eating disorder patients falsify their weight?

Answer 10

drinking large volumes
stones in pockets, keys etc
multiple layers of heavy clothes

adhoc weighing a good idea

Question 11

Why might an eating disorder patient need to be in a medical ward?

Answer 11

metabolic stabilisation
abnormal electrolytes
other abnormal parameter

Question 12

What is the first observable change in refeeding syndrome?

Answer 12

hypophosphataemia
(within first 72h of refeeding)

Question 13

Refeeding syndrome clinical features

Answer 13

myopathy
rhabdomyolysis potentially causing renal failure
acute cardiac failure
respiratory failure
delirium
seizures
coma
arrhythmias
death

Question 14

Sepsis signs in eating disorder patient

Answer 14

deadly triad:
(low BMI)
hypoglycaemia
hypothermia
hypoalbuminaemia

(CRP/WCC may not rise)

GIVE BROAD SPECTRUM ABX)

Question 15

Refeeding syndrome biochemical abnormalities

Answer 15

hypophophataemia
hypokalaemia
hypomagnesaemia
low thiamine

Question 16

What should all eating disorder patients be given before refeeding begins?

Answer 16

IV pabrinex