Anorexia Nervosa

 

 

Considerations 

 

  •  ↓ gastric empyting & aspiration risk  

  •  Metabolic & electrolyte abnormalities:

    •  ↓Na, ↓K, ↓Mg, ↓PO4

    •   Hypoglycemia 

    •   Osteoporosis 

    •   Metabolic alkalosis from vomiting 

  •  Cardiovascular dysfunction: 

    • Hypovolemia

    • Cardiomyopathy (LV failure) 

    • Mitral valve prolapse 

    • Arrhythmias: ↑QTc, bradycardia   

    • Autonomic dysfunction 

  •  Malnutrition: 

    • Anemia 

    • Thrombocytopenia 

    • Osteoporosis, fracture risk 

    • Risk of re-feeding syndrome 

  •  Coexisting psychiatric disease: 

    • Possibly uncooperative 

    • Medications 

 


Goals/Optimization 

 

  • Minimize aspiration risk: fasted, aspiration prophylaxis 

  • Rule out cardiomyopathy & underlying arrhythmias 

  • Assess functional capacity/ECG/echocardiogram

  • Fix underlying electrolyte abnormalities

  • Very careful with glucose management (risk of refeeding syndrome & electrolyte shifts with replacement)  

  • Avoid hypothermia 

  • Careful positioning with osteoporosis 

  • Multidisciplinary management including consultation with internal medicine, endocrinology, psychiatry