Pediatric Eating Disorders
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| What are the DSM-IV-TR classifications for eating disorders? | Anorexia Nervosa (AN), Bulimia Nervosa (BN), eating disorder not otherweise specified
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| True or False? 62% of girls and 29% of boys said they were trying to lose weight | True
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| What are the risk factors for eating disorders | Affective disorder, anxiety disorder, activities that emphasize a lean physique, childhood sexual/physical abuse, depression, dissatisfaction with body image, early onset of menses, low self-esteem, obsessive behaviors
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| How can you detect eating disorders? | Rarely present with an admitted ED, may be referred by a concerned parent, friend or coach, fatigue, dizziness, HA, constipation, heartburn, amenorrhea, growth chart
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| What are some screening tools that can be used? | how much would you like to weigh? how do you feel about your present weight? are you or anyone else concerned about your present eating or exercise habits?
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| What are the DSM-IV criteria for AN | Refusal to maintain body weight at or above normal, intense fear of gaining weight, disturbed body image, amenorrhea in postmenarchal females
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| What are some critical red flags for AN | ritualistic eating habits, refusal to eat in front of others, suddenly becoming a vegetarian, choosing to eat only low-fat, no-fat or lo cal food, continual exercising, hypersentivity to cold
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| What are the two types of anorexia | restricting and binge-eating/purge
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| What is BN | The hunger of an ox, binge-eating is the cetnral feature, usually don't fall below 85% of IBW
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| What is the DSM-IV criteria for BN | recurrent episodes of binge eating (eating more than most people and a sense of lack of control over eating during the episode). Recurrent inappropriate compensatory behavior to prevent weight gain, occur at least 2x/wk, undul influenced by body image
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| What are some of the inappropriate compensatory behaviors exhibited by pts with BN | laxatives, diuretics, enemas, fasting, excessive exercise
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| what are some clinical red flags for BN | Frequent excuses to go to the bathroom after meals, mood swings, hoarding food, unusal swelling around the jaw, laxatives or diuretic wrappers found in trash cans
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| What are some similarities between AN and BN | Preoccupation w/food and body wt, disturbed body image, poor self-esteem, fear of loss of control, high prevalence of depression, may alternate between illnesses
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| What are some differences between AN and BN | anorexic's emaciation often leads others to bring them to medical attn, BN are aware that their behavior is abnormal
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| What are osme medical complications of AN | loss of fat sotres and lean muscles mass, brgotr puberty, growth/development/sexual maturation stops, compensatory slowing of metabolism, medaites by thyroid hormone. Purging pts suffer additional consquences
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| What are the clinical presentations of AN | Denial of illness is the hallmark, AN should be suspected in any pt with unexplained wt loss
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| What are some common complaints of pt with AN | post prandial bloating, constiptation, cold intolerance, amenorrhea
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| What would you expect on ROS and PE Endocrine, Hematologic, Derm, Immunologic | Endocrine: amenorrhea, fertility issues, Thyroid (low T4, LowT3 normal TSh), Heme: anemia, leukopenia, thromobocytopenia, Derm: Russell's sign, lanugo, hair loss, dry skin. Immu: incr suscept to infections
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| What are cardiac, GI, renal signs on ROS and PE | Card: dystrhytmia, cardiomyopathy, orthostatic changes in BP, bradycardia, murmur, MVP, GI: loss of tooth enamel, dental caries, swelling of salivary glands, GERD, mallory-weis (upper GI bleeding), esophageal rupture, constipation. Renal failure.
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| what are Neuro and MS clinical presnetation of AN | Neuro: Sz, myopathy, peripheral neuropathy. MS osteoporosis, pitting edema, cold extremities, acrocyanosis, stress fractures
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| What are complications of BN | chronic vomiting, laxative abuse, diuretic abuse
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| What are complications of chronic vomiting | gastric & sophagel irritation and bleeding, volume depletion, hypochloremic metabolic acidosis, hypokalemia, reversible painles parotid gland swelling, irreversible dental errosion, ipecac complicatins (myopathy, cardiomyopathy)
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| What are complications of laxative abuse | transient wt loss, watery diarrhea, volume depletion, electrolyte loss, gi bleeding or rectal prolapse
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| What are the consequences of diuretic abuse | hypochoremic metabolic alkalosis, hypokalemia, volume depletion, dilutional hyponatremia
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| What are some clues to BN | preoccupation w wt & food, frequent wt fluctuations, dizziness, syncope, muscle cramps, weakness, paresthesias, heartburn, constipation, rectal bleeding
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| What are signs specific to BN | Russell's sign, dental caries, loss of enamel, gum disorders, parotid hypertophy, mallory weiss tears, esophageal rupture
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| What are the lab findings with BN | Metabolic alkalosis, Hyperchloremic metabolic acidosis, hypokalemia, hypomagnesemia, hyperphsophatemia, hypophosphatemia, hyponatremia
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| what are the goals of treatment for BN | normalizing body wt, addressing medical complications, reducing symptoms through cognitive & behavioral therapy, nutrition education, management & counseling, individual & family therapy
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| what is the duration of treatment for AN & BN | An: long term Rx required, BN: short term Rx can be very effective
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| What is the management for AN/BN | Labs: CBC, CMP, magnesium, TSH, prolactin & serum HCG if amenorrhea or irregular menses, Bone density testing, 12 lead EKG, transthoracic echo, regular wt check, psych, dietitian, activity/ex plan constip oral GERD Lg edema hypoka osteop wt gain
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| What is the refeeding syndrome | characterized by CV collapse, cardiac arrest and/or delirum. Can result from feeding high caloric nutrients too soon to malnourished pts
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| What medications are appropriate for AN/BN | antidepressants (Fluoxtine 60 mg/day), Anxiolytics (Xanax), HRT/OCP: Rx for osteoporosis
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| When should you hospitalize an AN/BN | when there are serious physical or metabolic complications: BP<90/5-, HR <40, renal failure, sev anemia, sz, LOC, dehydration, CP or heart failure, muscle spasm, UO < 40cc/day, pre/syncope, sev electrolyte imb
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| Other criteria for possible hospitalization | need for nourishment, inability to control binging/purging after 3 months of outpt Rx, cognitive impairment that interferes w judgement
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| what are some comorbid conditions that may be criteria for possible hospitatlization | Depression, bipolar, OCD, PTSD, substance abuse.
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| What is the female athlete triad | disordered eating, amneorrhea osteoporosis
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| Who are at risk for male eating disorders? | gay or bisexual men, models and actors, sports, most have a h/o premorbid obesity, substance abuse common, poore prognosis than women
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| What is the prognosis for AN | AN: 50% achieve complete recovery, 21% intermediate outcome, 26% poor outcome overal mortality rate 9.8%,
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| What is the prognois for BN? | 50% full recovery, 30% occasional relapse, 20% maintained full criteria for BN
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| What is the differential diagnosis for AN/BN | malignancy, IBD (inflammatory bowel disease), malabsorption, celiac dise, DM, hyp/hyperthyrodism, Addison's disease, depression, HIV, chornic illness
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