PART 3 / CH 44
Eating Disorders: Medical Issues
Roy Perlis
A. Indications for hospitalization
1. Body weight £ 75% of ideal body weight (IBW)
IBW= 100 lb. (5’ tall) + 5 lb. per additional 1” (women)
IBW= 106 lb. (5’ tall) + 6 lb. per additional 1” (men)
( BMI = weight (kg) / height (m)^2 ; normal = 20-25 )
2. Imminent medical risk: abnormal lytes, dehydration, malnutrition
3. Escalating or severe symptoms, with failure of outpatient mgmt
4. Other psychiatric emergency (risk of self harm, e.g.)
5. Arrested growth/development
B. Elements of evaluation
| Anorexia | Bulimia | |
|---|---|---|
| Physical findings | vitals: bradycardia, hypotension, hypothermia exam: lanugo, hair loss, dry skin, acrocyanosis, neuropathy | parotid enlargement, submandibular adenopathy, loss of tooth enamel |
| Labs | dehydration, acidosis or alkalosis, hypokalemia leukopenia, anemia, thrombocytopenia | hypokalemia, acidosis or alkalosis |
| Complications | amenorrhea, growth retardation, pubertal delay, osteopenia, arrhytmias, decreased GI motility | irregular menses, esophageal tears, gastric rupture, arrhythmias |
| Useful labs | - all: lytes, glucose, CBC - abnl lytes: EKG - amenorrhea: FSH, PRL, betaHCG - osteopenia: bone density | - all: lytes - abnl lytes: EKG |
source: Becker A (2000) Eating Disorders. In: Psychiatry Update and Board Preparation, 20