Emergency Department Management of Eating Disorder Complications in Pediatric Patients

Points & Pearls Excerpt

• Compared with other psychiatric disorders, eating disorders are associated with the highest mortality rates. Early screening and consultation with psychiatry improves long-term care and reduces relapse.
• Strict dieting as well as a history of childhood abuse are risk factors for developing an eating disorder. Obese children, athletes, models, and dancers are especially susceptible to developing an eating disorder.
• Patients with eating disorders may present with common emergency department (ED) complaints such as abdominal pain, chest pain, syncope, or palpitations. These patients also have high rates of mood disorders and substance abuse. A mindful history and the SCOFF questionnaire (see Table 3) can be used to screen for eating disorders.
• Physical examination may reveal growth stunting, lanugo, sialadenosis, dental erosion, enamel loss, calluses on the dorsal side of the hand (Russell sign), low blood pressure (< 90/60 mm Hg), and bradycardia.
• A complete blood cell count, complete metabolic panel, magnesium, and phosphorus should be obtained for all patients with a suspected eating disorder. Additional diagnostic studies for evaluation of complications depends on presenting symptoms: chest x-ray, electrocardiogram, and telemonitoring for chest pain or bradycardia/hypotension; creatine kinase for muscular pain; and plain films or magnetic resonance imaging (MRI) for skeletal pain.

Most Important References

• Trent SA, Moreira ME, Colwell CB, et al. ED management of patients with eating disorders. Am J Emerg Med. 2013;31(5):859-865. (Review article)
• Sachs K, Mehler PS. Medical complications of bulimia nervosa and their treatments. Eat Weight Disord. 2016;21(1):13-18. (Review article)
• Mascolo M, Trent S, Colwell C, et al. What the emergency department needs to know when caring for your patients with eating disorders. Int J Eat Disord. 2012;45(8):977-981. (Review article)
• Galetta F, Franzoni F, Prattichizzo F, et al. Heart rate variability and left ventricular diastolic function in anorexia nervosa. J Adolesc Health. 2003;32(6):416-421. (Case-control study; 50 participants)
• Stanga Z, Brunner A, Leuenberger M, et al. Nutrition in clinical practice-the refeeding syndrome: illustrative cases and guidelines for prevention and treatment. Eur J Clin Nutr. 2008;62(6):687-694. (Case report; 7 patients)