Round 1
These are 5 out of 9 Red Flags for a person having an eating disorder
What are: 1) Rapid weight gain or loss, 2) BMI<18.5, 3) Non-specific GI sx (Constipation, abd. pain, nausea) especially if loosing weight, 4) Electrolyte problems or anemia w/o other cause, 5) Bradycardia, orthostatic tachycardia/hypotension, 6) Irregular menses / amenorrhea/infertility without a cause, 7)Type 1 diabetes w/ persistently elevated A1c and frequent DKA (diabulimia), 8)Abnl urine specific gravity indicating dehydration vs. water loading, 9) Alkaline urine looking for purging.
This process causes refeeding syndrome in pts with severe malnutrition
What is increased protein synthesis and deficits of phosphate and magnesium?
Even when pts with eating disorders don't want formal treatment, this is 1 out of 3 reasons regular visits are helpful for harm reduction
What are: 1) Regular screening for medical complications of eating disorders, 2) Encourage treatment later, when pt feels ready, 3) Emphasize that recovery is possible, even after decades of illness
This may be a good indication to evaluate for self-induced vomiting
What is a young person with normal or low eight with hoarseness?
This first line treatment of osteoporosis often can not be used in people with eating disorders. Why?
What is exercise? It may become excessive and lead to further weight loss. Eating disorder must have stabilized before recommending it.
These are 4 out of 8 General or Cardiorespiratory symptoms from eating disorders.
1) Hypothermia, 2) Cold intolerance/hot flashes, 3) weakness/fatigue/lethargy, 4) Presyncope/syncope, 5) Chest pain/palpitations, 6) peripheral edema/ pericardial effusions, 7) Bradycardia/orthostatic hypotension, 8) Myocardial atrophy/mitral valve prolapse
This process causes death from refeeding syndrome
What is severely low phosphate leading to cell death, rhabdomyolysis and organ failures, +/- other electrolyte issues?
This is why it is important to not equate normal labs and vitals as signs of recovery.
It may invalidate a pt who is still feeling loss of control and overwhelming emotional distress.
These are 2 out of 3 reasons Progestin only methods of birth control may not be ideal for women with eating disorders
What are: 1) They can worsen amenorrhea, 2) They can lower bone mineral density, 3) They can cause weight gain.
This is a reason that bone health can be damaged in people with eating disorders long after eating issues have resolved.
What is abnormal bone development?
Round 6
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Round 7
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Round 8
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Round 9
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This is currently the most important treatment of bone loss in eating disorders.
What is restoration of weight and normal hormonal functioning?
These are 2 out of 3 inflammatory cytokines elevated in anorexia nervosa.
What are IL-1, IL-6, TNFalph?
These are 2 out of 4 symptoms that should raise the suspicion for superior mesenteric artery syndrome (SMA)
What are 1) Postprandial epigastric pain, 15 to 20 min after eat, relieved in several hours, 2) pain worse when lying down, 3) Nausea which is relieved by emesis, 4) Abdominal exam benign, mild tenderness, no rebound or guarding
True/False: A person with AN or BN who has acute onset epigastric pain and is not on a PPI, can be safely observed while starting the PPI.
What is false? Epigastric pain can be from acute gastric dilatation which can be life threatening.
This treatment is effective in AN-induced osteopenia/osteoporosis, but has problems with long term use and pregnancy. State what the drug is and what the problem is.
What are bisphosphonates? They have long T1/2 (10 years) and can damage fetal bone structure.
Rare case reports have shown this response to immunosuppressive therapy in pts with AN
What is resolution of AN symptoms?
This is the best treatment for SMA syndrome. Why?
What is weight restoration. It restores the fat pad surrounding the superior mesenteric artery and can cure Superior mesenteric artery syndrome.
These include 1) gastric perforation and 2) gastric necrosis
What is 1 of 2 life threatening complications of acute gastric dilitation