Thin Teenager Flashcards
What are the risks of rapid weight loss?
- Refeeding syndrome risk (metabolic disturbances occurring due to re-nourishing starved patients)
- Hypoglycaemia
- Risk of infection
- Cardiac arrhythmia
What are investigations to be done in a thin teenager?
- Height and weight
- HR
- Temperature
- Lying and standing BP
- BM
- RR
- CRT
What would a history of rapid weight loss include?
- Abdominal pain, malaena, diarrhoea, joint pains, bloating, fever
- Body image: ‘feeling fat’, preoccupation with calories, won’t eat, vegan, exercising, perfectionist shape, clothes now loose, new clothes size
- FH of eating disorder, FH of major mental illness
- Drugs/alcohol in family
- Menstrual hx, vomiting, binging, laxative use, amount being eaten and drunk, hiding food, excess exercise, safeguarding issues
What conditions can cause rapid weight loss in adolescents?
- Coeliac disease
- T1DM
- Hyperthyroidism
- Malignancy
- Anorexia nervosa
- IBD
- Oesophageal problems e.g. achalasia
- Severe depression/OCD/autism
- Juvenile arthritis
- Addison’s disease
What test might you do in extreme/sudden weight loss?
- ECG
- U+E, BM, phosphate, Ca, Mg
- LFTs
- CRP, ESR, WCC
- TFTs
- Anti-TTG
What does emaciated mean?
Abnormally thin or weak, especially because of illness or lack of food
What is the management for a starved individual?
- Admit to stabilise physically
- Commence vitamins (thiamine, vit B complex, multivitamins) to prevent refeeding syndrome
- Regular obs and BM
- Monitor bloods
- Contact local eating disorders team - diet plan
- IV fluids if hypoglycaemic or not drinking (10% dextrose and 0.45% saline)
When is someone at risk of refeeding syndrome?
If weight to height ratio <75% then need to give vitamins. Children who are starved will adapt by reducing their metabolic state and are at risk of metabolic decompensation when being refed.
What is lanugo hair?
Hair growth e.g. on cheeks - response to loss of insulating effect of fat tissue
What other blood test results can present in a thin teenager?
- Likely dehydration if not drinking
- Decreased WCC could represent haematological malignancy, however decreased WCC can be seen with weight loss - obtain blood film
- Liver abnormality can be caused by weight loss due to depletion of glycogen - test for glandular fever, Hep A, B and C, coagulation screen and liver USS
What is the short term (physical stabilisation) treatment for anorexia nervosa?
- Weight for height ratio <75% - commence thiamine, vit B complex and multivitamins
- Diet plan: aim for 0.5-1kg per week weight gain. An initial drop in weight may be noted as body leaves starvation mode.
- Monitor bloods (especially phosphate)
- Regular ECGs
- Discharge when vital signs stable and weight gain occurring, discuss with ED team regarding discharge and treatment plan.
What do you monitor in case of refeeding syndrome?
Phosphate - drop in phosphate is a marker of refeeding syndrome and may precipitate respiratory arrest (increased food uptake triggers protein/fat/glycogen synthesis, which require phosphate, K and magnesium). These are already depleted but decrease further upon refeeding.
What is beriberi?
Inflammation of nerves and HF, due to B1 deficiency (thiamine)
What is the medium term treatment for anorexia nervosa?
MDT treatment package in community:
- Child psychiatrist diagnoses and oversees care
- Prescribes medication
- Directed treatment for co-morbidities e.g. fluoextine for OCD
- Dietician gradually increasing diet plan to be agreed and adhered to
- Avoid supplements - patients need to learn to eat
- Therapists (often nurses) work on changing thought processes - takes time
- Family therapist looks at family dynamics - very stressful disease - different personalities have varying abilities to cope
- Paediatrician monitors physical health
- Concern re long-term risk of osteopenia and osteoporosis especially in young ladies with amenorrhoea. Role of DEXA scan for monitoring BMD.
What is the long term relapse prevention for anorexia nervosa?
- Transition phases e.g. going to univeristy
- Long-term outlook - 80% cure
- 3rd sector e.g. BEAT charity
- Risk of severe enduring eating disorder
