Anorexia nervosa: Difference between revisions
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==Background== | ==Background== | ||
*Associated with body image disturbance | *Associated with body image disturbance | ||
* | *Usually seen in adolescent girls | ||
**3rd most common chronic condition in adolescent girls | |||
**Life long risk | **Life long risk | ||
*Body image is predominate measure of self worth | *Body image is predominate measure of self worth | ||
*Mortality 6-20% | *Mortality 6-20%, highest of any psychiatric disorder | ||
==Clinical Features== | ==Clinical Features== | ||
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*Loss of subcutaneous fat | *Loss of subcutaneous fat | ||
*Breast and vaginal atrophy | *Breast and vaginal atrophy | ||
===Associated conditions=== | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 35: | Line 38: | ||
*Major depressive disorder | *Major depressive disorder | ||
*[[Schizophrenia]] | *[[Schizophrenia]] | ||
*Substance | *[[Substance abuse]] | ||
*Social anxiety disorder | *Social [[anxiety]] disorder | ||
*Obsessive-compulsive disorder | *Obsessive-compulsive disorder | ||
*[[Bulimia nervosa]] | *[[Bulimia nervosa]] | ||
==Evaluation== | ==Evaluation== | ||
*Exclude: Inflammatory bowel disease, hyperthyroidism, chronic infection, diabetes mellitus, and Addison’s disease<ref>John F. Bober, Scott E. Moser: Rakel: Textbook of Family Medicine, 8th ed., Saunders, 2011 (Ch)24: p452</ref> | *Exclude: Inflammatory bowel disease, hyperthyroidism, chronic infection, diabetes mellitus, and Addison’s disease<ref>John F. Bober, Scott E. Moser: Rakel: Textbook of Family Medicine, 8th ed., Saunders, 2011 (Ch)24: p452</ref> | ||
*CBC | *CBC | ||
**[[Anemia]], [[leukopenia]] in severe disease | |||
*Chem 10 | *Chem 10 | ||
**[[Hypoglycemia]], [[hypophosphatemia]] in severe disease | |||
*[[ECG]] | *[[ECG]] | ||
==Management== | ==Management== | ||
*Inpatient management | *Treat medical complications<ref>https://pedemmorsels.com/eating-disorders/</ref> | ||
**Cardiovascular | |||
***[[Bradycardia]] due to increased vagal tone | |||
***Other serious [[dysrhythmias]] | |||
***Decreased cardiac muscle from malnutrition --> cardiac dysfunction, [[mitral valve prolapse]] | |||
***Caution with rate of [[IVF]] (risk of [[pulmonary edema]]) | |||
**Fluid/Electrolytes | |||
***Serious [[electrolyte abnormalities]] can occur | |||
****[[Hypophosphatemia]] can impair cardiac and diaphragmatic muscle contractions--> [[respiratory arrest|respiratory]]/[[cardiac arrest]] | |||
****[[Hypomagnesemia]], [[hypokalemia]] and alterations with refeeding can cause [[arrhythmia]] | |||
***[[Refeeding syndrome]] risk | |||
***Even 1L of d5 NS could harm patient subsisting on <400kcal daily | |||
**Gastrointestinal | |||
***Delayed gastric/colonic emptying--> [[gastroparesis]], distension, [[GERD]], [[constipation]], [[SMA syndrome]] | |||
**MSK | |||
***Osteoporosis due to HPA dysfunction | |||
***Risk of fracture with minimal or no trauma | |||
==Disposition== | |||
*Inpatient management for: | |||
**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) | **Hypotension (< 80/50) | ||
| Line 59: | Line 81: | ||
**Severe or intractable purging | **Severe or intractable purging | ||
**Psychosis or a high risk of suicide | **Psychosis or a high risk of suicide | ||
==Also See== | ==Also See== | ||
Revision as of 16:57, 14 September 2019
Background
- Associated with body image disturbance
- Usually seen in adolescent girls
- 3rd most common chronic condition in adolescent girls
- Life long risk
- Body image is predominate measure of self worth
- Mortality 6-20%, highest of any psychiatric disorder
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
Associated conditions
Differential Diagnosis
- Gastrointestinal disease
- Hyperthyroidism
- Occult malignancies
- AIDS
- Major depressive disorder
- Schizophrenia
- Substance abuse
- Social anxiety disorder
- Obsessive-compulsive disorder
- Bulimia nervosa
Evaluation
- Exclude: Inflammatory bowel disease, hyperthyroidism, chronic infection, diabetes mellitus, and Addison’s disease[2]
- CBC
- Anemia, leukopenia in severe disease
- Chem 10
- Hypoglycemia, hypophosphatemia in severe disease
- ECG
Management
- Treat medical complications[3]
- Cardiovascular
- Bradycardia due to increased vagal tone
- Other serious dysrhythmias
- Decreased cardiac muscle from malnutrition --> cardiac dysfunction, mitral valve prolapse
- Caution with rate of IVF (risk of pulmonary edema)
- Fluid/Electrolytes
- Serious electrolyte abnormalities can occur
- Hypophosphatemia can impair cardiac and diaphragmatic muscle contractions--> respiratory/cardiac arrest
- Hypomagnesemia, hypokalemia and alterations with refeeding can cause arrhythmia
- Refeeding syndrome risk
- Even 1L of d5 NS could harm patient subsisting on <400kcal daily
- Serious electrolyte abnormalities can occur
- Gastrointestinal
- Delayed gastric/colonic emptying--> gastroparesis, distension, GERD, constipation, SMA syndrome
- MSK
- Osteoporosis due to HPA dysfunction
- Risk of fracture with minimal or no trauma
- Cardiovascular
Disposition
- Inpatient management for:
- 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
Also See
References
- ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- ↑ John F. Bober, Scott E. Moser: Rakel: Textbook of Family Medicine, 8th ed., Saunders, 2011 (Ch)24: p452
- ↑ https://pedemmorsels.com/eating-disorders/