Thin Teenager Flashcards
Hx
Body image, ‘feeling fat’, pre-occupation with calories, won’t eat, vegan, exercising, clothes loose / down clothes size
FH - eating disorder, drug / alcohol misuse, mental illness
Menstrual Hx, vomiting, bingeing, laxative use, amount being eaten and drunk, hiding food, excessive exercise, safeguarding issues
Suggestive of organic disease
Abdominal pain Melaena Joint pains Bloating Fever
DDx
Coeliac disease T1DM Hyperthyroidism Malignancy Anorexia IBD Severe depression / anxiety / ASD Juvenile arthritis Addisons
Assessment
BMI NOT ACCURATE - weight for height formula used instead
Vital signs, BM, FBC, ESR, CRP, renal function, liver function, thyroid function, coeliac screen, bone profile, ECG etc
Anorexia
Muscle loss - low creatinine, fatigue including breathing, cardiac muscle loss can lead to bradycardia, hypotension, CCF Electrolyte - low K, Mg, phos Thiamine deficiency Amenorrhea (stops / not started by 15) Bloating, nausea, constipation Bone marrow shut down Osteoporosis Dry, scaly skin Brittle hair, hair loss, lanugo hair Halitosis Brain atrophy and encephalopathy - ataxia, confusion, death
Anorexia features
Most things low
Gs and Cs raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
Refeeding Syndrome
Causes secretion of insulin - cells take in already low levels of K, Mg, phos. Serum levels become dangerously low. This can lead to heart arrhythmias and sudden death.
Hypomagnesaemia
Hypophosphataemia
Hypokalaemia
Low thiamine
Management
Admit to stabilise, commence vitamins (thiamine, vitamin B complex, multivitamins) to prevent refeeding syndrome, regular obs and blood monitoring
Contact local eating disorders team, diet plan
IV fluids if not drinking / hypoglycaemic (10% dextrose + 0.45% saline)
Points
Low WCC can be caused by malignancy but can also be seen with weight loss - obtain blood film
Liver abnormality can be caused by weight loss. Further tests: glandular fever, hep A, B, C, coag screen, ultrasound
Short term: Physical stabilisation
Weight for height ratio: if less than 75% commence thiamine, vitamin B complex and multivitamins
Diet plan: aim for 0.5-1.0kg per week gain (initial drop as body exits starvation mode)
Monitor bloods for refeeding syndrome (especially phos)
Regular ECGs
Discharge when vital signs stable and weight gain occuring
Medium term: MDT tx in community
Child psychiatrist - oversee care and prescribe for co morbidities
Dietician - avoid supplements
Therapists - often nurses and family therapists
Paediatrician to monitor physical health
Long term: prevent relapse
Transition phases
80% cure
BEAT charity
Risk of severe enduring eating disorder
