Eating Disorders and Refeeding Syndrome Flashcards
What are the suicide rates for Bulimia Nervosa
7x higher than general population
25-40% have attempted suicide in the past
What are the suicide rates for anorexia nervosa?
5x higher than general population
8-27% have a history of attempted suicide
What are teh DSM5 criteria for AN?
restriction of energy intake leading to low body weight
intense fear of gaining weight or becoming fat
distorted perception of body weight/shape
What are some questions in the Eating Disorder Screen for Primary Care?
- Are you satisified with your eating patterns
- Do you ever eat in secret
- Does your weight affect the way you feel about yourself?
- Have members of your family suffered with an ED?
- Do you currently or in the past suffered with an ED?
Describe the Restricting type of AN?
3 months of no binging or purging
-may see excessive exercising, fasting, and dieting
What is the Binge-Purging type of AN?
3 months of binging and purging
-may see self induced vomiting, misuse of laxatives, diuretics or enemas
Paradoxically, fear of weight gain may increase as what decreases?
As pt’s weight decreases and they become thinner, they fear weight gain even more
What are some cardiac complications of AN?
Bradycardia,
QT dispersion
Cardiac atrophy
hypotension
What are some GI and GU complications of AN?
Amenorrhea and decreased libido
Gastroparesis and constipation
What are some endocrine complications of AN?
Osteoporosis
hypotehermia
euthryoid
hypoglycemia
What are some electrolye complications of AN?
Dehydration
Hypokalemia
Hypophosphatemia
Hypomagnesemia
What are some Pulmonary and Hematologic complications of AN?
Resp. muscle atrophy and dyspnea
anemia, leukopenia, thrombocytopenia
What are some neurological and dermatologic complications of AN?
brain atrophy
xerosis
lanugo
carotenoderma
acrocyanosis
SD
What happens if a pt is rehydrated or fed beyond their current capacity?
Re-feeding syndrome-very serious, do not over feed
What is Re-Feeding Syndrome?
complication that occurs as a result of fluid and electrolyte shifts during aggressive nutritional rehabilitation of malnourished patients
What are some fatal outcomes of re-feeding syndrome?
hypophosphatemia
hypokalemia
CHF
Peripheral edema
Rhabdomyolysis
Sz
Hemolysis
How can re-feeding syndrome be avoided?
carefully limit amount of calories and fluids in the early stages of refeeding
avoid very rapid increases in daily calories
closely monitor labs in first few weeks
What other conditions are associated with AN?
OCD, OCPD
Perfectionism, compulsivity, narcissism
What are the goals of nutritional rehab for AN patients?
work with a RD
2-3lbs per week for inpatient care
0.5-1lb per week for outpatients
start with 30-40kcal/kg and increase as needed
goal to bring t back to normal body weight and teach proper eating and self-care
What are the therapy options for AN patients?
CBT
Specialist supportive clinical management
motivational interviewing
family therapy (good for adolescents)
*choice of therapy based on pt preference
What are some considerations when chosing pharm agents for AN patients?
If therapy has not been helpful and pt willing to take meds, start at low dose
avoid bupropion due to sz risk
avoid TCA due to cardiotoxicity
Caution with antipsychotics or antidepressants that can prolong QT
What are two good drug choices in AN and why?
Olanzapine can help with weight gain
Lorazepam can help with meal associated anxiety
When should SSRIs be considered in AN treatment?
If anxiety/depression is inhibiting the pt from continuing care
may consider 2nd gen antipsychotic if depression is unresponsive to SSRIs
What is the DSM 5 defintion of Bulimia Nervosa?
Binging without a sense of control in a short period of time
Followed by inappropriate compensatory behavior to prevent weight gain
Occurs at least 2x per week for 3 months
While pt’s with AN are almost exclusively underweight, pt’s with BN can be
slightly underweight, overweight, normal weight or obese
How do pt’s with BN tend to feel during and after purging and what is their goal?
They may feel out of control and ashamed during the binge
Often feel dysphoric after the binge
Typically don’t want to lose weight, but want to avoid gaining weight
What are some electrolyte complications of BN?
Dehydration
Hypokalemia
Hypochloremia
Metabolic Alkalosis
What are the cardiac complications of BN?
hypotension
orthostasis
sinus tachy
ECH changes
arrhythmias
What are some GI complications of BN?
MW tear
Esophageal rupture
Parotid and submandibular gland hypertrophy
Abdominal pain/bloating/constpiation
What are some dental and skin complications of BN?
tooth erosions/caries
scar/callus on dorsum of hand (Russel’s Sign)
xerosis
What is the best treatment for BN?
nutritional rehab, CBT and pharm
What drug should be avoided in BN treatment?
Bupropion due to increased Sz risk with binging and purging
What is the first line drug agent for BN?
What is 2nd line treatment for BN?
What is 3rd line treatment for BN?
Fluoxetine
Other SSRIs (Sertraline or Fluvoaxamine)
TCA, Topiramate, Trazodone, MAOIs
What is Binge Eating Disorder?
Same as binge-purge but without the purge part
What is the first and only medication approved to treat moderate to severe BED in adults?
vyvanse
What is the first line treatment for BED?
CBT and IPT
