Class 4 Flashcards
(38 cards)
At risk anorexia
female, young, depression, medical comorbidities
at risk bulimia
change in weight, bulimia, anxiety, vital signs, medical comorbidities
at risk BED
not as young, increase in weight, male or female, anxiety, impulsivity, depression, GI problems, mestrual prb, metabolic syndrome
What to ask screening
- Are you trying to lose weight, have you lost weight, are you still losing weight?
- What are you doing to lose weight?
- Do you ever lose control over how much you eat?
- Would you say that food dominates your life?
- Body image question
Worrisome sx
loss of consciousness convulsions weakness: get out of chair BMI ≤ 15 Weight loss ≥ 1 kg /week x 3 months Pregnancy Type 1 diabetes Weakness or syncope Sodium < 130 Potassium < 3.0 Abnormal liver function tests Bradycardia < 45; Prolonged QTc Orthostatic changes : BP drops by ≥ 20; Pulse increases by ≥ 20 Hypothermia (≤ 35.0°C) Contact us: Medical risk management
basic labs to do
CBC Albumin, Total Protein Glucose Random Creatinine Sodium, Potassium, Chloride, Bicarbonate ALT (Alanine aminotransaminase); AST (Aspartate aminotransaminase) if alcoholic CK (Creatinine kinase) Calcium, Magnesium, Phosphate B12 HbA1c (if diabetic) TSH Other recommended tests Electrocardiogram (ECG)
Elevated CK
intense exercise
potassium low, increase Cl and CO2
induced vomiting
increased ALT
liver damage because malnourished
WBC low
bone marrow suppression in the case of chronic under eating. Not more prone to illness
Physical consequences
Arrhythmia Bradycardia Osteoporosis Amenorrhea Hypokalemia Hypothermia Hypophosphatemia Hypotension
Starvation leads to
energy conservation: decrease in temperature, pulse, BP, turn off reproductive factors
dehydration: water conservation mechanisms turn on: decrease BP increase pulse
Starvation uses up
reserves: fat, muscle and bone, other tissues
Effect of vo
Teeth Throat Salivary glands Stomach Blood in vomit
Effect of laxatives
Cramps
Bloating
Diarrhea
Blood in stool
Most common s/symptoms: or purging
dizziness and poor concentration Gastroesophageal reflux (heartburn); dental problems, parotid gland enlargement Elevated amylase (normal lipase); metabolic alkalosis (elevated CO2)
when weight decreases, what increases
compulsivity and hyperactivity
PRIORITY 3
Normal weight
No daily bingeing or purging
No medical complications
PRIORITY 2
BMI: 15-18 (women); 16 -19 (men) or sign of medical instability
With at least one symptom
Syncope Laxatives > 10 co./day Hypokalemia < 2.8 mmol/L Fasting > 2 days/week Multiple purging episodes per day
PRIORITY 1
BMI: < 15 (women); < 16 (men) or Drastic weight loss
1 kg/week x 3 months
Significant medical instability i.e. syncope, bradycardia, ↓↓ potassium
Fasting : 2 days/week
Pregnancy
type 1 db
transfer from adolescent services
Proposed criteria to send patient to ER
BMI < 12 (female) <13 (male) or rapid and drastic weight loss.
•Plus at least one or more of the following:
–Ongoing weight loss
–Syncope
–Weakness
–Bradycardia HR< 40 bpm or HR > 110 bpm
–Hypothermia <34.8 C
–Hyponatremia <120 mmol/L or <125 mmol/L and symptomatic
Regardless of weight:
–Hypokalemia < 2.8 mmol/L or hypokalemia with abnormal EKG and/or significant metabolic alkalosis (CO2 >38 mmol/L)
–Signs and symptoms of severe dehydration
To ignore labs
- Low T3 (metabolic compensation)
* High cholesterol
pharmaco bulimia
SSRIs and other antidepressants are useful.
pharmaco BED
SSRIs, SNRIs, and medications associated with appetite and weight reduction, such as the stimulant LDX (Vyvanse), work.
