Short term complications
A 17-year-old with anorexia nervosa presents with fatigue and dizziness on standing. Which combination of vital sign findings is most likely?
Bradycardia and hypotension
This long-term complication results from reduced oestrogen or testosterone, low IGF-1 activity and inadequate nutritional intake, increasing the risk of fractures.
What is osteoporosis?
Check for anaemia, leukopenia and thrombocytopenia (may be due to bone marrow suppression or nutrient deficiency)
What is a FBC
What is refeeding syndrome?
A potentially life-threatening metabolic disturbance that occurs when nutrition is reintroduced after prolonged malnutrition or inadequate food intake.
Which mechanism best explains loss of periods (amenorrhoea) in a young woman with anorexia nervosa?
Suppressed GnRH release from the hypothalamus, causing low LH, FSH and oestrogen
Prolonged starvation suppresses hypothalamic GnRH secretion, reducing LH and FSH. This endocrine disturbance can cause amenorrhoea and impaired fertility.
What is hypogonadotropic/secondary hypogonadism?
Test for hypokalaemia, hypochloraemia and metabolic alkalosis from vomiting and laxative/diuretic misuse. (severe malnutrition may also reduce renal function)
What is Urea, electrolytes and creatinine (UEC) and VBG
Which three electrolytes are most commonly affected in refeeding syndrome?
Phosphate, potassium and magnesium.
Delayed stomach emptying (gastroparesis) is common in anorexia nervosa. Which symptom does it typically cause?
Early fullness and bloating after small amounts of food
A patient with severe anorexia nervosa develops a potentially life-threatening arrhythmia. Name two electrolyte abnormalities that may contribute to this complication.
What are hypokalaemia and hypomagnesaemia?
Looking for signs of starvation
What is ketones (urine or blood), blood glucose
What is the hallmark electrolyte abnormality of refeeding syndrome?
Hypophosphataemia (low phosphate levels in the blood).
Fine, soft body hair called lanugo appears in some people with anorexia nervosa. It is most commonly thought to be...
The body's attempt to conserve heat after losing insulating fat
A patient experiences fatigue, impaired concentration and declining academic performance, subsequently withdrawing from friends and becoming increasingly anxious about eating. Using the biopsychosocial model, identify the three interconnected domains contributing to this cycle.
What are the biological, psychological and social domains?
Malnutrition contributes to fatigue and cognitive impairment, anxiety reinforces restrictive eating, and social withdrawal reduces support and worsens distress.
to see if malnutrition has cause hypothalamic suppression
What is FSH, LH, Oestradiol
Why does refeeding cause electrolyte levels to drop?
Carbohydrate intake increases insulin secretion, causing phosphate, potassium and magnesium to shift from the blood into cells.
Which mechanism best explains early bone mineral density loss in females with anorexia nervosa?
Low oestrogen lowers OPG, so RANKL drives more osteoclast formation and bone resorption
A severely malnourished patient begins nutritional rehabilitation and develops profound hypophosphataemia, muscle weakness and cardiac dysfunction. What condition do they have?
What is refeeding syndrome?
Check for bradycardia or arythmias
What is an ECG
What vitamin should be administered before or during refeeding in at-risk patients, and why?
Thiamine (vitamin B1), because it is essential for carbohydrate metabolism and its deficiency can cause serious neurological complications, including Wernicke encephalopathy.