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Eating Disorder, Emergency Medicine

Rohn S. Friedman Reviewed 06/2017
 


Basics

Description

Anorexia Nervosa (AN)

  • Restriction of intake, leading to markedly low body weight for age, height, and/or developmental trajectory

  • Intense fear of gaining weight or becoming fat, or beh...

Diagnosis

Signs and Symptoms

History

  • Rapid or sustained weight loss

  • Typical detailed day's eating pattern shows restricting and/or bingeing behavior

  • Purging (vomiting, laxatives, diuretics, enemas)

  • Excessi...

Treatment

Initial Stabilization/Therapy

  • ABCs

  • Careful fluid resuscitation for dehydration to avoid precipitating peripheral or pulmonary edema

  • Replete phosphate and thiamine since both may drop with refee...

Follow-Up

Disposition

Admission Criteria

  • Medical risk:

    • Extremely low weight (<75% IBW)

    • Rapid weight loss

    • Serum electrolyte imbalance (K <3, glucose <60)

    • Bradycardia <40

    • BP <90/60

    • Orthostasis (...

Pearls and Pitfalls

  • Eating disorders are associated with high medical risk and risk of suicide; prioritize safety assessment

  • Rapid restoration of nutrition, volume resuscitation, and/or failure to repl...

Additional Reading

  • Aigner  M, Treasure  J, Kaye  W, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of eating disorders. World J Biol...

Codes

ICD9

  • 307.1 Anorexia nervosa

  • 307.50 Eating disorder, unspecified

  • 307.51 Bulimia nervosa

  • 307.59 Other disorders of eating

ICD10

  • F50.00 Anorexia nervosa, unspecified

  • F50.2 Bulimia nervosa

  • F50.9 Eating diso...

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