Suzanne DooleyHash MD FAED October 22 2020 Academy for Eating Disorders Webinar Objectives Recognize medical complications of eating disorders including associated potentially life threatening conditions ID: 928010
Download Presentation The PPT/PDF document "What Every Emergency Physician Needs to ..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
What Every Emergency Physician Needs to Know About Eating Disorders
Suzanne Dooley-Hash, MD, FAEDOctober 22, 2020Academy for Eating Disorders Webinar
Slide2Objectives
Recognize medical complications of eating disorders including associated potentially life threatening conditions. Describe an appropriate medical evaluation for a patient with a known or suspected eating disorder in the acute care setting.
Identify and manage a medically compromised or unstable eating disorder patient.
Determine appropriate levels of care for eating disorder patients who present to the emergency department.
Slide3Take Home Points
Eating disorders are not rare.
Eating disorders come in all shapes and sizes.
Many individuals with eating disorders are much sicker than they look.
Slide4Impact of Eating Disorders
Slide5Eating Disorders and Healthcare
Slide6Epidemiology of
Eating Disorders
Slide7Prevalence and Types of Eating Disorders
Anorexia Nervosa (AN)Lifetime prevalence – 0.5 – 1.0%
Bulimia Nervosa (BN)
Lifetime prevalence – 1-3%
Binge Eating Disorder (BED)Lifetime prevalence – 2.5 - 5.3% Other Specified Feeding and Eating Disorder
Unspecified Feeding and Eating Disorder
Pica
Rumination
Avoidant/restrictive food intake disorder
Slide8Medical Complications of Eating Disorders
Slide9Common Signs and Symptoms
Common presenting complaints
:
Headache
Mood changesSore throatDizziness/syncope
Palpitations
Fatigue/generalized weakness
Sports-related or overuse injuries
Gastrointestinal (GI) complaints - indigestion, abdominal pain, bloating, constipation, and hematemesis
Slide10Clues
Slide11Cardiovascular Complications
Slide12Cardiovascular Complications
Cardiac atrophyMitral valve prolapseHypotension
Decreased exercise tolerance
Decreased cardiovascular response to exercise
Heart failure
Slide13Cardiovascular Complications
HypotensionOrthostasisEdemaSudden cardiac death
Slide14Gastrointestinal Complications
Acid-relatedGastroesophageal reflux (GERD)
Esophageal spasm
Trauma-related
Mallory-Weiss tearsBoerhaave’s
Syndrome
Slide15Complications Related to GI Slowing
Gastroparesis Constipation Hemorrhoids
Slide16Metabolic and Electrolyte Abnormalities
Hypokalemia
Mild
(3.0-3.5
mEq/L) - oral potassium supplementation 100-200 mEq
/L for each 0.5-1.0
mEq
/L deficit in serum potassium
Moderate
(2.5-3.0
mEq
/L) - admit, IVF (50-75 cc/hr for 1-2L) and potassium supplementationMust correct magnesiumSevere (<2.5mEq/L ) – MUST be admitted with cardiac monitoringPredisposes to fatal cardiac arrhythmias
Must correct any concurrent hypochloremic metabolic alkalosis
Slide17Metabolic and Electrolyte Abnormalities
Hyponatremia
Hypochloremia
Hypocalcemia – seizures, tetany, arrhythmias, numbness/tingling
Hypomagnesemia – arrhythmias, muscle weakness
Hypophosphatemia
Micronutrient deficiencies
Metabolic alkalosis
Hypothermia
Dehydration
Slide18Endocrine Complications
Hypoglycemia (< 70 mg/dL)
Hyperglycemia
Decreased bone mineral density
Slide19Psychiatric
Complications/ComorbiditiesIrritability/mood changesDepression
Anxiety
Self-harm
Substance abuseObsessive compulsive disorder
Suicide
Slide20Medical Evaluation of the Eating Disorder Patient
Thorough history and physical examination
Laboratory studies
Complete blood count
Electrolytes including magnesium and phosphorusKidney and liver function testsThyroid function tests
UA
Pregnancy test (if applicable)
Electrocardiogram (ECG)
Other studies as indicated
Slide21Common Laboratory Clues
Often normal even in advanced disease
Electrolyte abnormalities
Acid-base disturbances
Anemia (usually iron-deficiency)Neutropenia
Slightly elevated liver function tests
Elevated BUN
HCO3 abnormalities
Low erythrocyte sedimentation rate (ESR)*
Slide22ECG Abnormalities
Usually normal
Bradycardia
Prolonged QTc
Signs of hypokalemia
Slide23Guidelines for Hospitalization of an Eating Disorder Patient
Slide24Guidelines for Hospitalization of an Eating Disorder Patient
Slide25Pearls
Maintain a high index of suspicion Recognize high risk patientRecognize signs and symptoms consistent with an eating disorder
Supportive, non-judgmental stance
Involve family members and significant others
Recognize and treat all potentially life threatening abnormalities
Slide26Pitfalls
Avoid overly aggressive fluid administration
Beware the normal diagnostic studies
Disposition
Screen for suicidality
Slide27Take Home Points
Eating disorders are not rare.
Eating disorders come in all shapes and sizes.
Many individuals with eating disorders are much sicker than they look.
Slide28Resources