EM Psych 8: Eating Disorders

Question 1

remarks on anorexia nervosa

Answer 1

fear of weight gain or becoming fat, despite lower than predicted body weight

medical complications are typically more severe in anorexia than in bulimia or binge drinking
- complications are generally directly due to malnutrition and can account for a large proportion of deaths

Question 2

bulimia nervosa is diagnosed by the presence of

Answer 2

bingeing and purging at least 1 time a week for 3 weeks

Question 3

remarks on patients with bulimia or binge eating disorder

Answer 3

can be difficult to detect in the ED because they tend to be normal weight or overweight

self-induced vomiting can cause painless hypertrophy of the parotid glands (sialadenosis), trauma or callus formation to the dorsal hands (Russle’s sign)

Question 4

cardiac complications of anorexia

Answer 4

malnutrition causes decreased cardiac muscle mass and increased vagal tone –> bradycardia, hypotension

Relative decreases in cardiac muscle mass can lead to MVP

Increased QT dispersion

Question 5

remarks on QT dispersion

Answer 5

Increased QT dispersion
- difference bet maximum and minimum QT intervals seen in each lead of a single ECG
- indicates heterogeneous ventricular depolarization
- marker for increased arrhythmic risk
- reversed by adequate refeeding

QT resolution –> used to guide rehabilitation

Question 6

there is increased risk of cardiac complications during the _____ week of refeeding after severe nutrient depletion

Answer 6

first

Question 7

Wernicke-Korsakoff encephalopathy

Answer 7

Thiamine deficiency

Confusion, confabulation
Ataxia
Nystagmus
Ophthalmoplegia

Question 8

Refeeding following prolonged nutrient depletion can also cause electrolyte abnormalities, most commonly:

Answer 8

hypokalemia
hypophosphatemia
hypomagnesemia
due to redistribution of electrolytes from the extracellular to the intracellular space triggered by insulin release and from depletion of phosphorus during protein synthesis

This can lead to
- arrhythmias,
- CHF,
- pericardial effusions, and
- cardiac arrest

Question 9

Endocrine complications of anorexia

Answer 9

Hypothalamic amenorrhea

Euthyroid sick syndrome
- TSH is normal or slightly low
- T3 is low
- T4 is sometimes also llow
- thyroid deficiencies likely contribute to the bradycardia, orthostasis, and hypothermia in anorexia

Question 10

SCOFF questionaire

Answer 10

Sick
Control
One stone (14lb in 3 months)
Fat
Food

A score of 2 or more indicates a probable eating disorder with a sensitivity of 85% and specificity of 90%

Question 11

Some of Society of Adolescent Medicine Criteria for Hospital Admission for Anorexia Nervosa

Answer 11

Body weight <75% of ideal for age, sex, and height
Body fat <10% of body weight

Daytime HR <50
Nighttime HR <45
SBP <90
Orthostasis and syncope
Cardiac arrhtyhmia including QT prolongation
Temp <96f

Dehydration
Ongoing weight loss despite outpatient therapy
Acute psychiatric emergencies such as hallucinations or suicidality

Question 12

Society of Adolescent Medicine Criteria for Hospital Admission for Bulimia Nervosa

Answer 12

K <3.2
Cl <88
Esophageal trauma and hematemesis
Vomiting unresponsive to antiemetics

Orthostasis and syncope
Cardiac arrhtyhmia including QT prolongation
Temp <96F

Dehydration
Ongoing purging despite outpatient treatment
Acute psychiatric emergencies such as hallucinations and suicidality

Question 13

Most medical complications of anorexia nervosa can be treated in an outpatient setting if

Answer 13

patient’s weight is >70% of ideal body weight or BMI >15 kg/m2

Question 14

remarks on eating disorders in men

Answer 14

binge eating is more prevalent in men than both anorexia and bulimia