Anorexia Nervosa may not scare you but it should

Vicky Vella is an emergency physician practicing in the United Kingdom with a special interest and expertise in eating disorders. In December of last year, Vicky had a guest post on the St Emlyn’s blog about the MARSIPAN Guidelines. Never heard of them? Neither had pretty much anybody. MARSIPAN is an acronym for Management of Really Sick Patients with Anorexia Nervosa. Anorexia is often viewed as a chronic condition that doesn't really warrant emergency care, but that's not the case. Mortality with anorexia nervosa is high (on the order of 10-20%) and patients can present, as MARSIPAN suggests, really sick.   Consider an eating disorder/anorexia in patients presenting with Self Harm. Up to 70% of patients with anorexia will self harm Diabetic Ketoacidosis.  In the UK around half of 15-25 year olds with type 1 diabetes will withhold insulin to try and lose weight. Not all of them will have an eating disorder, but many will Vasovagal syncope. We often ask if a patient had breakfast or enough to drink today, but there may be an underlying eating disorder   What question(s) to ask Vicky starts with, "What's your relationship with food?" "Do you eat regular meals?" The patient may not disclose that there's a problem. Information may come from a family member   Who has anorexia nervosa Highest risk is 13-17 yo age group, both male and female Can actually affect all ages, races, genders   What's the difference between anorexia nervosa and someone who just doesn't eat much? Anorexia is a mental illness. Sometjing the person doesn't have much control over Less of a desire to be thin than a fear of being obese Guilt associated with eating May restrict intake, exercise to burn off consumed calories Often mood swings, social isolation, can become aggressive toward family DSM 5 Criteria Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.   Red Flags in the Anorexia Workup (from the MARSIPAN Guidelines) BMI low risk 15–17.5 medium risk 13–15 high risk

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