Feeding and Eating Disorders

Question 1

Restriction of energy intake relative to requirements. Presentation of significantly low weight, intense fear of gaining weight, undue influence of body weight/appearance on self-evaluation, and lack of recognition of danger of low weight.

Answer 1

Anorexia nervosa

Question 2

Lab/physical exam findings may include: metabolic/electrolyte imbalances (low Na, K, Cl) or elevated CO2, low protein/albumin, disruption of endocrine labs (FSH, LH, estradiol, TSH, T4, T3), and the presence of bony protrusions in frame/loss of subcutaneous tissue, bradycardia, cold, and lanugo growth on skin, arms, and back

Answer 2

Anorexia

Question 3

Recurrent episodes of binge eating and compensatory behaviors to prevent weight gain - vomiting, fasting, laxatives, excessive exercise, etc. Occurring on average at least once weekly for 3 months.

Answer 3

Bulimia nervosa

Question 4

Lab/physical exam findings may include electrolyte disturbances (low Na, K, Cl), metabolic alkalosis, cardiac or kidney disfunctions, dental erosion, and scarring on knuckles/fingers from forced vomiting (Russell’s sign). Individual may be normal or slightly overweight. May have full appearance in facies due to parotid and submaxillary swelling. May be tachy with orthostatic hypotension.

Answer 4

Bulimia

Question 5

Recurrent episodes of eating an amount of food larger than what most people would consume in a discrete amount of time (2 hours) under similar circumstances, and a sense of a lack of control over eating during this period. Episodes occur at least once weekly for 3 months and cause marked distress.

Answer 5

Binge eating disorder

Question 6

Disorders typically associated with OCD, expectations of high achievement, strained parent-child relationships, rigid and distorted ego, and strong learned associations between being slender/thin and attractiveness.

Answer 6

Eating disorders

Question 7

Pharmacotherapy may include Reglan or Phenergan to restore GI motility, estrogen, progesterone, folate, vitamins and minerals. Atypical antipsychotics and/or antidepressants to regain weight and control mood/psychotic symptoms. Cyproheptadine to restore weight.

Answer 7

Anorexia nervosa

Question 8

FDA approved for treatment of binge eating disorder (1), off-label use for binge eating disorder but should not be used for patients with anorexia or bulimia due to electrolyte disturbance and risk of seizures (2)

Answer 8

1 - Vyvanse, 2 - bupropion

Question 9

Hospitalization may be required for those with weight loss greater than 30% below baseline or BMI less than 16, cardiovascular compromise or altered mental status (significant dehydration).

Answer 9

Anorexia (possibly bulimia)