Anorexia Nervosa

  • Assessment

    Possible admission criteria (to be discussed with Adolescent Medicine consultant)

    1. Physical ( for nasogastric resuscitation )

    • Bradycardia (< 50 bpm)
    • Postural hypotension (fall in systolic BP lying to standing > 20 mmHg)
    • Dehydration
    • Hypothermia (temp. <35o C oral)
    • Electrolyte abnormalities (eg. hypokalaemia, hypernatraemia)
    • Severe weight loss (>30% of pre-morbid weight)

    Investigations:

    • Urea and electrolytes, creatinine, calcium, magnesium, phosphate
    • Urinalysis - including pH (possibility of diuretic use )
    • ECG (if K+ abnormal) A medical admission for resuscitation would usually result in a 4 week period of inpatient treatment.

    2. Psychiatric

    Patients with anorexia nervosa may be at risk of suicide or other at-risk behavior (eg. acute bulimic phase). These patients require urgent psychiatric assessment. On consultation with the adolescent consultant and the adolescent psychiatry team, admission may be considered. The admission is usually of shorter duration than if the patient were physically comprised.

    Notes

    Diagnostic Criteria (DSM-V)

    • Refusal to maintain body weight over a minimum normal weight for age and height
    • Intense fear of gaining weight or becoming fat, even though underweight
    • Distorted body image (not always clear particularly in younger patients)

    Follow-up

    All patients with eating disorders require close and expert monitoring and long-term therapy. This usually involves a combination of adolescent medicine and psychiatry out-patient support.

    All new patients with an eating disorder can be referred to see one of the adolescent medicine consultants or be seen at the Healthy Eating Clinic (both of these can be arranged through the Adolescent Centre - extn. 5890).