1. •Anorexia Nervosa
•Bulimia Nervosa
•Eating Disorder NOS

3. • Inquire about how patient feel about their body?
• Have they tried to lose weight? How have they dieted?
• Ask about weight history and dietary intake?
• Purging history (vomiting, laxatives, emetics)
• Menstrual history (irregular cycles, secondary
amenorrhea)
• Symptoms secondary to malnutrition pr purging
(dizziness, syncope, fatigue, hair loss)
• The adolescent with an eating disorder often has one of
these other symptoms without an overt complaint about
weight

4. • The physical examination findings are often
normal especially in bulimics who are
generally within 10 pounds of ideal body
weight.
• Weigh the patient in gown only after
voiding.
• Hypothermia, bradycardia, hypotension,
postural hypotension may be present if the
patient is malnourished
• Coldness and edema of the extremities
• Hard stool in the rectal vault
• The patient who has been vomiting may
have lost tooth enamel.

5. • Malnutrition can affect virtually every
organ system.
• Abnormalities can include electrolyte
alterations alone or with persistent
vomiting and diuretic or laxative use.
• Compromised renal function, bone
marrow suppression, mild liver
inflammation, suppressed thyroid
function with low free T4 and TSH
levels
• Perform electrocardiogram if the
patient is hypokalemic

6.  Mild:
• recent onset of
symptoms and
physiologically stable
• and not less than 85%
of ideal body weight
 Moderate:
• Not less than 75% of
ideal body weight
• Depression without
suicidal ideation
• Physiologic
abnormality:hypother
mia or hypokalemia
Severe:
• <75% of ideal body weight
• Evidence of metabolic disorder:
• Heart rate <40
• Temperature <36c
• Systolic blood pressure <70mmhg
• Orthostatic hypotension
• Serum k<3.0
• Severe dehydration
• Severe depression with suicidal
ideation
Very severe:
• Dehydration
• Electrolyte imbalance (depressed
serum Mg, P)
• Arrhythmia

7. • Treat :
Nutrition counseling
Explain to the patient and family that the patient may be
struggling with emotional issues; the focus on eating
and weight may be the patient’s attempt to maintain a
sense of control in life when feeling is over helmed
• Consider:
Psychiatric assessment
• Follow-up:
Assess in 2-4 weeks
 If there is no improvement; it’s moderate
eating disorder

8. • Psychiatric assessment
Treat:
o Intensive outpatient management
o Nutrition
o Behavioral contact
o Psychotherapy
• Follow-up:
o Assess every 1-2 weeks
 If improves …follow up assess monthly
 If relapses :treat intensive outpatient management
 Consider:
Day treatment and residential care
 If worsens so hospitalize

9. • Hospitalize
Treat:
o Medical stabilization
o Begin refeeding
• Follow-up:
o Monitor for refeeding syndrome
Treat:
o institute psychotherapy
o Behavioral contract
 If Good response:
 Discharge to intensive outpatient or day treatment program
 Follow-up: assess weekly
o If relapses intensive outpatient management
o If worsens psychiatric hospitalization and residential treatment
 If poor response:
 Treat and consider: psychiatric hospitalization and residential treatment