Troubles alimentaires Flashcards
when elements are important to obtain on a history of a patient with a ?eating disorder
patients history + symptoms + behaviours
patients height + weight history
restrictive and binge eating
exercise patterns and their changes
purging and other compensatory behaviours
core attitudes regarding weight, shape and eating
associated psychiatric conditions
family hx of eating disorders or other psychiatric disorders (including etoh and SUDs)
family history of obesity
family interactiosn with regard to patients disorder
family attitudes towards eating, exercise and appearance
what should you pay particular attention to on physical exam in patients with eating disorder
vital signs
height and weight
cardiovascular and peripheral vascular function
dermatological manifestations
evidence of self injurious behaviours
calculation of BMI
who should be referred for bone density assessment
those who have been amenorrheic for more than 6 months
what element of the history is particularly important to obtain in ?eating disorders
safety assessment
at what weight does it become very difficult for someone to gain weight outside of a highly structure program
those who weigh less than approx. 85% of their individually estimated healthy weights
list factors that suggest hospitalization may be appropriate for a patient with eating disorder
rapid or persistent decline in oral intake
decline in weight despite maximally intensive outpatient or partial hospitalization interventions
presence of additional stressors that may interfere with the patient’s ability to eat
knowledge of the weight at which instability previously occurred int he patient
co occurring psychiatric conditions that merit hospitalization
degree of the patient’s denial and resistance to participate in his or her own care in less intensively supervised settings
what is the prevalence of BN in women? AN?
BN–> 3%
AN–> 1%
what % of those with eating disorders achieve recovery? partial recovery?
40-45%–recovery
30%–partial recovery
what % of those with eating disorders have a chronic course
about 25%
what is the standardized mortality rate for eating disorders? what are usually the causes of mortality in eating disorders
SMR–> 5-15%
due to malnutrition, medical complications, suicide
up to 50% of deaths in AN are due to complications of starvation
remaining 50% due to suicide or comorbid substance use
at what BMI does the APA guidelines recommend admission to a medical unit for AN
BMI of 15 at initial presentation (lectures slides indicate this is a bit of an arbitrary set point)
note that lower weight = longer weight restoration will take
below what BMI are those with an eating disorder at risk
16 and below
what lab result is associated with sudden death in AN
fasting BG below 2.5
indication of severe starvation
low sugars do not present
how does AN affect the kidneys
chronic renal failure is common
biopsies done demonstrate injury due to repetitive volume insult to the renal tubules
kidneys affected by poor intake, volume loss, excess exercise, purging, laxative use or diuretic use
what types of criteria are considered when deciding what level of care to offer a patient with an eating disorder
suicidality
% of healthy body weight
motivation to recover
co-occurring disorders
ability to control exercise
purging behavours
environmental stress
geographic availability of tx
list the 9 criteria from a “medical status” standpoint considered for acute inpatient admission for ADULTS for eating disorders
- heart rate below 50 bpm
HTO: Increase 30 bpm
20mmHg drop systolic
- BP below 90/60
- electrolyte imbalance
Hypokaliémie
Hyponatrémie
Hypoemagnésémie
Hypophosphatémie
- temp below 36 C
IMC < 15
> 10% perte de poids en 6 mois
20% perte de poids en 2 ans
Comportements purgatoires fréquents
- hepatic, renal or CV compromise requiring acute treatment
QTc > 450ms
Anomalies ECG significatives
list the 6 criteria considered for KIDS AND TEENS for acute inpatient admission for eating disorder
- heart rate below 40 bpm
HTO: Increase 40 bpm
20mmHg drop systolic
- BP below 90/45
- electrolyte imbalance
Hypokaliémie
Hyponatrémie
Hypoemagnésémie
Hypophosphatémie
- temp below 36 C
<75% IMC pour âge et sexe
> 10% perte de poids en 6 mois
20% perte de poids en 2 ans
Comportements purgatoires fréquents
- hepatic, renal or CV compromise requiring acute treatment
QTc > 450ms
Anomalies ECG significatives
what weight as % of healthy body weight is considered appropriate for outpatient treatment of eating disorder
above 85%
what type of patient, with regard to the following factors, would be appropriate for outpatient treatment for AN/eating disorder:
- medical status
- suicidality
- weight as percentage of body weight
- motivation to recover
- co occuring disorders
- structure needed to gain weight
- ability to control compulsive exercising
- purging behaviour
- environmental stress
- geographic availability of treatment program
- medically stable to the extent that more extensive medical monitoring (as defined by levels 4 and 5 of level of care–see other cards–is not required)
- depends on level of suicide risk on assessment; if felt to be low risk, outpatient may be appropriate
- above 85% healthy body weight
- fair to good motivation
- comorbid conditions do not require inpatient treatment independently
- self sufficient for eating/gaining weight, does not require significant support
- can manage compulsive exercise through self control
- can greatly reduce incidents of purging in an unstructured setting; no significant medical complications from purging like ECG changes
- others are able to provide adequate emotional and practical support and structure
- patient lives near treatment setting
how do you treat hypoglycemia + low weight AN
indication for refeeding on a medical ward
treat with IV glucose and THIAMINE
watch amount of glucose you give while waiting for medical team
what is “refeeding syndrome”
electrolytes shifting–> K, PO4, Mg
what is one of the first signs of refeeding syndrome
tachycardia –> this is an indication to DECREASE feeding
