Eating Disorders A guide to management & referral pathways in the RPAH Emergency Department.
Eating disorders are associated with significant psychiatric and medical morbidity. Eating disorders are serious, life-threatening, psychiatric illnesses and are not a lifestyle choice. In addition to individuals presenting with the medical sequelae of an eating disorder, individuals may also present to the Emergency Department with no history or diagnosis of an eating disorder, but have, for example, recently lost a significant amount of body weight and are at risk of refeeding syndrome and other medical complications.
Assessing for symptoms of eating disorders can be difficult as patients may feel uncomfortable disclosing health-related information. Consider interviewing the patient with family members (with consent of the patient) to help ascertain an accurate clinical picture.
Effective management of a patient with an eating disorder requires close collaboration between medical and psychiatric staff. The overarching principle is that each patient is entitled to access the level of treatment determined by their psychiatric and / or medical needs.
Key symptoms of eating disorder presentations may include: Low body weight for age and height or failure to achieve expected weight gain Fear of fatness or fear of weight gain Preoccupation with weight and shape Restricted dietary intake Self-induced vomiting Misuse of laxative, diuretics or appetite suppressants Excessive, compulsive exercise Binge eating episodes unusually large amounts of food Amenorrhoea or failure to reach menarche in women; loss of libido in men Acute medical symptoms may include: Dehydration Electrolyte imbalance Hypothermia Syncope Cardiac arrhythmias (especially bradycardia) Suicidal ideation or suicide attempts Overwhelming infection, renal failure Bone marrow suppression, GIT dysfunction Acute gastric dilation from binge eating A thorough physical examination is necessary and must be completed. Also order the following investigations: BMI ECG Full blood count including electrolytes, glucose, renal function, liver function, thyroid function (T3, T4, TSH), calcium, magnesium, phosphate, amylase, ESR. Urinalysis Warning signs If patients exhibit any of the following, physician consultation and potential hospital admission is indicated:
Sections adapted from NSW Health: Mental Health for Emergency Departments A Reference Guide (2009) DRAFT Version 3, 27.05.2013