Inpatient AN Management

This course will help orient pediatric residents to the inpatient management of anorexia nervosa patients

List the criteria for inpatient management of anorexia nervosa

How to calculate a patient's percent of eIBW

Using the charts below, find the patient's height in cm and their age.  This will give you the 100% eIBW for the patient.  Patients aged less than 12 or over 17 are outliers and can be discussed when they come up

Diagnostic Criteria for Anorexia Nervosa

1) Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health) 

2) Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain (even though significantly low weight)

3) Disturbance in the way one's body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Various Admission Criteria for Anorexia Nervosa

1) Bradycardia less than 50 bpm

2) Systolic BP <90 mm Hg

3) eIBW <75%

4) Significant ketonuria

5) Significant electrolyte abnormalities

6) Temperature <36 degrees C

7) Failure of intensive outpatient management

List the lab tests ordered as part of an initial workup and that are monitored initially at admission

Lab and electrolyte testing

Lab tests ordered as part of an initial anorexia nervosa workup (and may be monitored on occasion as needed)

1) Chem 10 (this is ordered initially and then Q48 x4)

2) Vit. D 25, OH

3) DEXA scan (as needed at admission based on duration of amenorrhea and/or malnutrition)

4) LFTs (may show transaminitis).  Patients with edema may have normal albumin levels

5) Lipase (if patient has a history of purging via vomiting)

Determine a safe number of calories to begin feeding a new anorexia nervosa patient

How many calories should you start feeding a new anorexia nervosa admission?

List the criteria to advance the level of physical activity of an anorexia nervosa patient

Criteria to advance physical activity

1) Vital signs stable

2) eIBW > 70-75% initially, then advanced at 80%

3) Able to tolerate position changes without significant orthostatic dizziness or hypotension

List the criteria for hospital discharge of anorexia nervosa patients

Hospital Discharge Criteria

1) eIBW >85%

2) Able to gain weight or maintain weight eating all unobserved meals

3) Electrolyte abnormalities have corrected

4) Vital signs have stabilized at or above normal