Anorexia nervosa: Difference between revisions
| Line 49: | Line 49: | ||
==Management== | ==Management== | ||
* | *Inpatient management | ||
**Extremely low weight (<75% of expected body weight) or rapid weight loss | **Extremely low weight (<75% of expected body weight) or rapid weight loss | ||
**Hypotension (< 80/50) | |||
**Hypothermia (< 96 degrees F) | |||
**Severe electrolyte imbalances | **Severe electrolyte imbalances | ||
**Cardiac disturbances | **Cardiac disturbances | ||
**Bradycardia < 50 | |||
**Acute medical disorders | **Acute medical disorders | ||
**Severe or intractable purging | **Severe or intractable purging | ||
Revision as of 05:16, 9 October 2018
Background
- Associated with body image disturbance
- Adolescent girls
- Life long risk
- Body image is predominate measure of self worth
- Mortality 6-20%
Clinical Features
Diagnostic Criteria
- A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. [1]
- B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
- C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Symptoms
- Constipation
- Abdominal pain
- Fatigue
- Weakness
- Amenorrhea
- Depression
- Hair loss
Signs
- Fine facial and body hair (lanugo)
- Brittle hair and nails
- Dry, scaly skin
- Loss of subcutaneous fat
- Breast and vaginal atrophy
Differential Diagnosis
- Gastrointestinal disease
- Hyperthyroidism
- Occult malignancies
- AIDS
- Major depressive disorder
- Schizophrenia
- Substance use disorders
- Social anxiety disorder
- Obsessive-compulsive disorder
- Body dysmorphic disorder
- Bulimia nervosa
- Avoidant/restrictive food intake disorder
Evaluation
- Exclude: Inflammatory bowel disease, hyperthyroidism, chronic infection, diabetes mellitus, and Addison’s disease[2]
- CBC
- Chem 10
- ECG
Management
- Inpatient management
- Extremely low weight (<75% of expected body weight) or rapid weight loss
- Hypotension (< 80/50)
- Hypothermia (< 96 degrees F)
- Severe electrolyte imbalances
- Cardiac disturbances
- Bradycardia < 50
- Acute medical disorders
- Severe or intractable purging
- Psychosis or a high risk of suicide