Anorexia Nervosa
Considerations
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↓ gastric empyting & aspiration risk
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Metabolic & electrolyte abnormalities:
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↓Na, ↓K, ↓Mg, ↓PO4
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Hypoglycemia
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Osteoporosis
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Metabolic alkalosis from vomiting
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Cardiovascular dysfunction:
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Hypovolemia
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Cardiomyopathy (LV failure)
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Mitral valve prolapse
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Arrhythmias: ↑QTc, bradycardia
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Autonomic dysfunction
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Malnutrition:
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Anemia
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Thrombocytopenia
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Osteoporosis, fracture risk
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Risk of re-feeding syndrome
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Coexisting psychiatric disease:
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Possibly uncooperative
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Medications
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Goals/Optimization
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Minimize aspiration risk: fasted, aspiration prophylaxis
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Rule out cardiomyopathy & underlying arrhythmias
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Assess functional capacity/ECG/echocardiogram
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Fix underlying electrolyte abnormalities
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Very careful with glucose management (risk of refeeding syndrome & electrolyte shifts with replacement)
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Avoid hypothermia
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Careful positioning with osteoporosis
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Multidisciplinary management including consultation with internal medicine, endocrinology, psychiatry