Eating Disorders and Refeeding Syndrome - Hill Flashcards
restriction of energy intake relative to requirements, leading to significantly low body weight for age, sex and development
- intense fear of gaining weight or becoming fat despite being underweight or persistent behavior that interfered with weight gain
- distorted perception of body weight
anorexia nervosa (AN)
- wt loss often viewed as a form of control, self esteem may largely revolve around weight and body image
- distortion of body image is described as an idea of overvaluation rather than a delusion
what is asked on an eating disorder screen for primary care?
- are you satisfied with your eating patterns?
- do you ever eat in secret?
- does your weight affect the way you feel about yourself?
- have any members of your family suffered with an eating disorder?
- do you currently suffer with or have you ever suffered in the past with an eating disorder?
3 months of NO binging or purging
- no self induced vomiting or use of laxative
- excessive exercising, fasting, dieting
restricting type AN
3 months of binging and purging behaviors
- self-induced vomiting
- misuse of laxative, diuretic, enemas
bind-eating/purging type AN
what are the medical complications of AN?
- cardiac: bradycardia, hypotension, PT dispersion, cardiac atrophy, MVP
- gynecologic: amenorrhea, decreased libido
- electrolyte: dehydration, hypokalemia, hypophosphatemia, hypomagnesemia
what is a serious complication of AN tx?
refeeding syndrome
- do NOT rehydrate of feed beyond their current capacity
- *can develop third spacing and other serious complications** d/t fluid/electrolyte shifts during aggressive nutritional rehabilitation of malnourished pts
- hypophosphatemia, hypokalemia, CHF, peripheral edema, rhabdomyolysis, seizures, hemolysis
how do you avoid refeeding syndrome?
- judiciously limit the amount of calories and fluid provided in the early stages of refeeding
- avoid very rapid increases in the amount of daily calories ingested
- closely monitor (labs) during the first few weeks of refeeding process
what are the most important comorbidities seen with AN?
- mood disorders: depression and dysthymic disorder
- anxiety disorders: OCD
- impulse control disorders
- personality: borderline, dependent
what is the tx for AN?
- interdisciplinary team including dietician, mental health, and general medical clinician
- nutritional rehab and psychotherapy
- hospitalization until normal weight is achieved
- usual intake of 30-40 kcal/kg that is progressively increased to match body tolerance and weight gain goals
what is the first line therapy for AN?
- *psychotherapy** that focuses on helping patients confront their disorder and change eating habits/thoughts
- choice based on pt preference: CBT, specialist clinical management, motivational interviewing
when should pharmacotherapy be considered for AN?
only for pts who have been resistant to other therapies and who are willing to take meds
- start at low doses d/t increased risk of side effects associated with low weight/dehydration
- AVOID BUPROPRION d/t increased seizure risk w/binging and purging
- caution with antipsychotics and antidepressants with risk of QT prolongation
which meds can be used in AN?
- olanzapine (only med shown to help with weight gain)
- if anxiety or depression is severe enough to create barriers to care, then consider SSRI
- SGA may be considered if depression is unresponsive to SSRI’s
recurrent episodes of binge eating, defines as eating an unusually large amount of food in a discrete period of time
- pts usually feel they cannot control their eating during the episode
- recurrent inappropriate compensatory behavior to prevent weight gain
- usually normal body weight, slightly underweight, overweight or obese (not usually underweight)
bulimia nervosa (BN)
- pts often excessively fearful of weight gain
- purging behaviors used to counteract weight gain from binge-eating
is BN divided into purging and non-purging categories similar to AN?
yes
what are the medical complications of BN?
- GI: mallory-weiss syndrome, esophageal rupture, parotid/submandibular gland hypertrophy
- dental/skin: tooth enamel erosion and dental caries, scar/callous on dorsum of hands (Russel’s sign)
