Eating Disorders

Question 1

What are the DSMV criteria for anorexia nervosa?

Answer 1

• Restriction of energy intake leading to a body weight significantly lower than expected given age, gender, development
• Intense fear of gaining weight and getting fat, and fear of activities that would prevent weight loss
• Disturbance in the way one’s body is perceived or lack of appreciation of the damaging effects of the low weight

Question 2

What is the treatment for anorexia nervosa?

Answer 2

• Education regarding nutrition and lifestyle
• Nutritional rehabilitation
• Psychotherapy regarding maladaptive thoughts, attitudes and feelings
• Treatment of medical complications
• Relapse prevention
• Family therapy
• Adjunction medication eg olanzapine

Question 3

Which electrolytes must be closely monitored during refeeding as they typically fall?

Answer 3

Mg
Phosphate
Potassium
Thiamine

Question 4

What are some medical complications of AN?

Answer 4

Amenorrhea or reduced fertility
Osteopenia or fractures
Dry skin
Hypothermia
Constipation or atonic bowel (due to laxative use)

Question 5

What are the DSMV criteria for bulimia nervosa?

Answer 5

A) Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
a. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
b. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B) Recurrent inappropriate compensatory behaviors in order to prevent weight gain,such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
C) The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
D) Self-evaluation is unduly influenced by body shape and weight.
E) The disturbance does not occur exclusively during episodes of anorexia nervosa.

Question 6

What are the ECG findings in hypokalaemia?

Answer 6

Widespread U waves, QTC 450

Question 7

What Ix do you do for AN? What might you get?

Answer 7

ECG: Widespread U waves, QTC 450
UEC: Hypokalaemia
LTF: Elevated AST, ALT, GGT
FBE: Anaemic (normochromic, normocytic), WCC, Plt, and ESR are low

Question 8

What is refeeding syndrome?

Answer 8

Insulin is low due to low CHO, and body stores of K, Mg and PO4 are depleted
Once CHO are supplemented, Insulin rises and K, PO4, and Mg shifts intracellularly
Usually occurs 3-4 days post

Question 9

What are the admission criteria for AN?

Answer 9

BMI20
Proximal myopathy

Children

• Hypoglycaemia
• Rapid weight loss
• Petechial rash

Question 10

What are the criteria for discharge with anorexia?

Answer 10

1. Medically stable
2. Psychologically stable
3. Discharge destination
4. Follow up organised
5. Trials at home completed
6. Low or no risk to self or others