Nutrition And EDs Flashcards
Anorexia nervosa
- ICD-10 Criteria
Anorexia nervosa ICD-10
- FEEDD
F ear of weight gain
E ndocrine disturbance
- Amenorrhoea
E maciated BMI
- <17.5kg/m2
D eliberate weight loss
D istorted body image - Neither of
- Recurrent binge-eating
- Preoccupation with eating
- 3 months history
Anorexia nervosa
- Risk factors
Anorexia nervosa RFs
- Female
- 10:1 - Mid-adolescence
- Puberty
- Criticism of weight/body/eating
- Hobbies or occupations encouraging a slim figure
Anorexia Nervosa
- Examination
Anorexia examination
- BMI
- Lanugo hair
- Russell’s sign
- Callus on back of hand
- Self-induced vomiting - Tooth decay and parotid swelling
- Hydration status
- Lying and standing BP - Abdo exam
- Gastritis
- Ileus - MSK SUSS test
- Supine-to-Up;
- Squat to Stand - Evidence of self-harm
Anorexia Nervosa
- Ix
Anorexia Nervosa Ix
Bedside
1. ECG
2. CBG
Bloods
3. FBC, Film
4 ESR, CRP
- U&E
- Phosphate
- Calcium
- Magnesium - LFT
- Coeliac screen
- TFTs
- Amylase
- Haematinics
MEED Approach
MEED
Managing Emergencies in Eating Disorders
- Assessing
- Refeeding
- Managing
Anorexia Nervosa
- Risk Assessment Components
Anorexia Nervosa
- Risk Assessment
- BMI
- CVS and ECG
- Hydration and temperature
- Biochemical status
- Activity and exercise
- DHS and suicide
- Mental health diagnosis
- Muscular weakness
9 Mallory Weiss tear etc.
Eating disorder
- Risk assessment grading
Eating Disorder RA
Blue
>85% median BMI
Green
80-85% median BMI
Amber
70-80% Median BMI
Red
<70% Median BMI
Anorexia Nervosa
- Complications
- CVS
- Other systems
- Long term
- Psych
Anorexia Nervosa
Common complications
1. CVS impairment
- Sinus brady.
- Postural h.
- Prolongued QTc
- Dizziness/fainting
- Re-feeding
- Fluid & Electrolytes
- Thermoregulation
- GI motility
- Muscle wasting
Long term
- Growth
- Pubertal delay
- Early osteoporosis
- Neurocognitive impairment
Psychological
- Social withdrawal
- Low mood and anxiety
- Low self-esteem
- Irritability and rigidity of thinking
- DSH and Suicidal ideation with plan
Anorexia Nervosa
- Admission Indications
Anorexia Nervosa Admission
- Severe malnutrition
- BMI <70% median
- Weight loss - 1kg/52 for 2/52 - CVS instabiility
- HR<50
- BP<80/50 or <0.4th centile
- Postural HR change >30bpm
- Orthostatic change >20mmHg - Neutropenia
- SUSS test
- Feeling of weakness
- Reduced power - OP/Spinal compression
- Abdominal pain
- Gastric dilatation
Refeeding syndrome
- Pathophysiology
Refeeding syndrome
- Calorific load
- Insulin release
- Cellular uptake of potassium
- Phosphate
- Magnesium - Reduced phosphate
- reduced ATP
- Arrhythmias
- Diaphragm dysfunction
- Rhabdomyolisis
- Seizures
Refeeding syndrome
- Prevention
Refeeding syndrome
Prevention
- Caution when refeeding
- Caution not to under-feed either
Suggested guidelines
- 10kcal/kg (NICE)
- 40kcal/kg (WHO)
- 45kcal/kg (Cape Town)
- Monitor closely
Bedside
- Daily ECG
- PEWS
- CBG
- Fluid balance
Bloods
- Electrolytes
- Baseline FBC, LFTs, CRP, Coeliac, TFTs, Vit D, Haematinics
Urine
- Electrolytes
Faltering growth causes
- Intake
- Calorie demands
- Calorie utilisation
Faltering growth
- Low intake
1. Commonest cause
2. Environmental/social/familial
3. Appetite
4. Feeding
5. Catch-up growth - Caloric demand
1. Chronic infection
2. Surgery
3. Chronic illness - Caloric utilisation
1. GI
2. Endocrine - DM
- Thyroid
3. Burns
Faltering growth
- Waterlow Criteria
Waterlow criteria
- Weight-for-length
- Percentage of median
80-90% mild
70-80% moderate
<70% severe
Faltering growth
- Three criteria
Faltering growth criteria
- Weight-for-length/BMI
- <5th percentile - Weight-for-age
- >2 centile drop - Length-for-age
- <5th centile
- > 2 centile drop
Faltering growth mx
- Mild
- Moderate
- Severe
Faltering growth
- 80-90% median w-f-l
1. Education
2. Diet + feeding behaviour
3. Social programme - 70-80%
1. Calorie and feeding review
2. Comprehensive review and physical exam
<70%
1. Behavioural treatment
2. Hospitalisation
- DDx
- Tx eg. Tube feeding
