Eating Disorders Flashcards
What are the core features of anorexia nervosa?
Refusal to maintain body weight >85% of expected range --> BMI <17.5 Intense fear of gaining weight Disturbance of body image Amenorrhoea Other co-morbid psychiatric conditions
Which electrolyte disturbances might be seen in anorexia?
Hypokalaemia
Hyponatraemia
What cardiac problems may occur in anorexia?
Low BP, low HR
Increased QTc interval
Arrhythmias
Cardiac arrest
Which GI problems might occur in anorexia?
Dental caries (vomiting) Enlarged parotid glands Discomfort and bloating Oesophageal tears (vomiting) Constipation or diarrhoea Incontinence Delayed gastric emptying Raised LFTs as liver broken down to provide energy
Which renal problems might occur in anorexia?
Damage from chronic hypokalaemia
Oedema and dehydration
- vomiting/laxatives/diuretics
Which neurological problems might occur in anorexia?
Deficiencies can lead to
- peripheral paraesthesia
- tetany
- seizures
Which endocrine abnormalities might occur in anorexia?
Amenorrhoea
Abnormal TFTs
Which dermatological problems might occur in anorexia?
Dry skin
Carotenaemic lanugo hair
Poor circulation
Hair loss
Which musculoskeletal problems might occur in anorexia?
Muscle wasting
Weakness
Osteopenia
Russel’s sign (calluses on back of hand)
What haematological problems might occur in anorexia?
Low WBC
Anaemia (iron, B12)
Bone marrow suppression
Thrombocytopenia
What are the psychological complications of anorexia?
Low mood + anxiety Irritability + anger Narrowed interests, social withdrawal Poor concentration, impaired decision making Drowsiness
What is the first line treatment for anorexia in children/adolescents?
Family based therapy (FBT)
What are the other psychological treatments for anorexia?
CBT
IPT (interpersonal therapy)
SSCM (specialist supportive clinical management)
Which medications might be used in anorexia?
Supplements e.g. vit D + calcium, vitamins
Antidepressants for low mood
What are the features of bulimia nervosa?
Recurrent binges + compensatory behaviours e.g. vomiting, excessive exercise or fasting Binge at least once a week for 3 months Russel's sign Dental caries Risk of oesophageal rupture
What is the treatment for bulimia nervosa?
Individual or group CBT
High dose fluoxetine may reduce cravings for food
What is avoidant restrictive food intake disorder?
Restrictive eating pattern –> failure to meet nutritional needs
- may be to do with sensory issues with food textures
- may be associated autism
What is binge eating disorder?
Binging at least once a week for >3 months without compensatory behaviours
What is re-feeding syndrome?
Potentially fatal shifts in fluid and electrolytes on re-feeding following a period of starvation
What is the hallmark of re-feeding syndrome?
Hypophosphataemia
Which electrolyte abnormalities may be seen in re-feeding syndrome?
Low phosphate Low potassium Low magnesium Abnormal fluids + sodium Thiamine deficiency
What are the risk factors for re-feeding syndrome?
Very low BMI Little/no nutrition for several days Alcohol/substance misuse Diabetes Elderly
What is the main symptom/sign of re-feeding syndrome?
Oedema
How is re-feeding syndrome prevented?
Give thiamine, vitamin B + multivitamin before commencing feeding, and for first 10 days after
Monitor glucose, Mg, PO4, K + Na before and every day for first week of re-feeding
