Diagnosis

• n/a

Investigation

Physical Examination:

• Lanugo hair, palor, brittle hair and nails, Peripheral cyanosis, Russell’s sign
• Eroded tooth enamel, Parotid Glands
• BMI
• Hypotension/Bradycardia (Heart Failure)

Blood Tests:

• FBC,ESR, U&E’s, TFT
• Bone profile (osteoporosis)
• Cholesterol
• Endocrine profile
• ECG
• ECHO – if indicated

Management

Acute

• Self-harm and suicide risk

Anorexia Nervosa

• Conservative
• Symptom-focused treatment regimen with the expectation of weight gain
• Dental review
• Refrain from physical sports where falls likely
• If BMI <13.5 treat as in-patient considering consent
• Can be sectioned under MHA
• Refeeding syndrome: ensuring electrolyte balance adequate
• Feeding against the will of the patient should be an intervention of last resort in the care and management of anorexia nervosa
• Medical
  • Little evidence
• Psychological Intervention
  • Family involvement in therapy useful
  • Cognitive Analytic Therapy (CAT) & CBT (Less treatment seeking, hence talking therapies less likely to be successful)

Bulimia Nervosa

• Conservative
• Dental review
• Medical
  • SSRI (Fluoxetine Prozac)
• Psychological Intervention
  • Interpersonal psychotherapy alternate to CBT

NICE Source: CG9 Eating disorders in over 8s: management. Summary compiled by Dr D P Sheppard MBBS.