Feeding or Eating Disorders

Question 1

What is anorexia nervosa?

Answer 1

Weight < 85% of ideal body weight or BMI < 17

Question 2

What are the 2 types of anorexia?

Answer 2

• Restrictive type: weight loss achieved through diet, fasting, &/or excessive exercise
• Binge eating/purging type: eating binges followed by self-induced vomiting &/or use of laxatives, enemas, or diuretics

Question 3

What are physical exam findings of anorexia?

Answer 3

• Emaciation
• amenorrhea
• abd pain
• constipation
• muscle wasting
• cold intolerance
• fatigue
• lanugo
• dryness
• hypotension
• bradycardia

Question 4

What are lab findings of anorexia?

Answer 4

• Leukopenia
• ↑ BUN & creatinine
• metabolic alkalosis
• hypochloremia
• hypokalemia
• ↓ T4/T3 & sex hormones

Question 5

What is the diagnostic criteria for anorexia?

Answer 5

restriction of energy intake relative to requirements, leading to a significantly low body weight
* (B) Intense fear of gaining weight or of becoming fat or persistent behavior that interferes with weight gain
* (C) Disturbance in the way in which one’s body weight or shape is experienced in the last 3 months

Question 6

How is the severity of anorexia classified?

Answer 6

by BMI
* Mild (≥ 17)
* Moderate (16-16.9)
* Severe (15-15.9)
* Extreme (< 15)

Question 7

How is anorexia treated?

Answer 7

restore nutritional state & psychotherapy
* Hospitilaze if weight is < 75% of expected body weight
* Goal 0.5-1lbs/week to prevent refeeding syndrome
* last line: olanzapine for weight gain

Question 8

What is refeeding syndrome?

Answer 8

Can occur if carbohydrates & sodium are introduced too rapidly after a period of starvation → phosphorus, potassium & magnesium deficiencies

Question 9

What are symptoms of refeeding syndrome?

Answer 9

• peripheral edema
• rhabdomyolysis
• seizures
• hemolysis
• respiratory insufficiency
• LHF
• arrhythmias

Question 10

What is diagnostic of refeeding syndrome?

Answer 10

hypophosphatemia, hypokalemia, & hypomagnesemia

Question 11

How is refeeding syndrome treated?

Answer 11

reduce nutritional support + aggressive correction of electrolytes

Question 12

What is bulima nervosa?

Answer 12

Frequent binge eating +/- purging but normal/overweight

Question 13

What are sxs of bulima?

Answer 13

• sialadenitis
• tooth enamel loss
• dental caries
• abd tenderness
• esophagitis
• dehydration
• scars on knuckles
• swollen parotid glands

Question 14

What lab findings would you expect to see in a patient with bulima using vomiting to compensate?

Answer 14

• metabolic alkalosis
• hypokalemia
• hypochloremia

Question 15

What lab findings would you expect to see in a patient with bulima using laxatives to compensate?

Answer 15

• metabolic acidosis
• hypokalemia
• hypochloremia

Question 16

What lab findings would you expect to see in a patient with bulima using diuretics to compensate?

Answer 16

• metabolic alkalosis
• hypokalemia
• hyponatremia
• hypocalcemia

Question 17

What is the diagnostic criteria for bulima?

Answer 17

Recurrent episodes of binge eating & inappropriate compensatory behaviors in order to prevent weight gain ≥ 1/wk for 3 months
* Binge eating: eating in a discrete period of time (MC 2 hrs), an amount of food that is larger than what most individuals would eat under similar circumstances, AND a sense of lack of control over eating during the episode
* Compensatory behaviors: self-induced vomiting, laxatives, diuretics, fasting, or excessive exercise

Question 18

How is bulima treated?

Answer 18

CBT + nutritional therapy + Fluoxetine or Citalopram
* Bupropion is contraindicated → seizures!