eMedicine Specialties > Emergency Medicine > Psychosocial

Anorexia Nervosa: Differential Diagnoses & Workup

Author: Tracy A Cushing, MD, MPH, Instructor in Medicine, Department of Emergency Medicine, Harvard Medical School; Attending Physician, Department of Emergency Medicine, Mount Auburn Hospital
Coauthor(s): Ron Waldrop, MD, MS, FAAP, FACEP, CPE, Consulting Staff, Commonwealth Emergency Physicians; Director of Pediatric Quality Care Management, INOVA Loudon Hospital; Adjunct Clinical Professor, Georgetown University School of Medicine
Contributor Information and Disclosures

Updated: Aug 21, 2008

Differential Diagnoses

Adrenal Insufficiency and Adrenal Crisis
Inflammatory Bowel Disease
Alcohol and Substance Abuse Evaluation
Mitral Valve Prolapse
Anxiety
Pediatrics, Dehydration
Constipation
Pediatrics, Diabetic Ketoacidosis
Depression and Suicide
Shock, Hypovolemic
Diabetes Mellitus, Type 1 - A Review
Sinus Bradycardia
Diabetes Mellitus, Type 2 - A Review
Hyperthyroidism, Thyroid Storm, and Graves Disease
Hypokalemia

Other Problems to Be Considered

Chronic gastrointestinal infections
Malabsorption
Malignancies

Workup

Laboratory Studies

  • No definitive diagnostic tests are available for anorexia nervosa; however, given the multiorgan system effects of starvation, a thorough medical evaluation is warranted.
    • A chemistry panel should be assessed for hypokalemic, hypocalcemic metabolic alkalosis caused by vomiting. Ionized calcium levels should detect hypocalcemia.
    • Hyponatremia may be seen due to excess water intake.
    • Low serum phosphorus levels less than 0.8 mmol/L should be repleted.
    • Liver function tests may be slightly elevated, but albumin and protein levels are usually normal.
    • A complete blood count may reveal a mild leukopenia secondary to margination as well as thrombocytopenia. Hemoglobin may be elevated with extreme dehydration, but is generally normal.
    • Fecal occult blood may be indicative of esophagitis, gastritis, or repetitive colonic trauma from laxative abuse.
    • Although it will not likely effect emergency department management, further studies such as erythrocyte sedimentation rate (ESR) and serum cholesterol level may be helpful.
    • Thyroid function tests, prolactin, and serum follicle-stimulating hormone levels can differentiate anorexia nervosa from alternative causes of primary amenorrhea.

Imaging Studies

  • Chest radiograph may reveal rib fractures from repetitive vomiting in the presence of hypocalcemia. Patients may also show evidence of osteopenia. Imaging is rarely necessary in the emergency department.
  • Radiographic evidence of emphysematous changes is present on the chest CT scan of patients with anorexia; however, unlike with COPD, these changes resolve with refeeding and weight normalization. Chest CT is not generally indicated as part of the ED evaluation.

Other Tests

  • ECG is helpful in evaluating the severity of malnutrition and risk for dysrhythmias in patients with metabolic abnormalities.
  • ECG findings are nonspecific but may include bradycardia and prolonged QT interval.

More on Anorexia Nervosa

Overview: Anorexia Nervosa
Differential Diagnoses & Workup: Anorexia Nervosa
Treatment & Medication: Anorexia Nervosa
Follow-up: Anorexia Nervosa
References
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References

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  2. Wilfley DE, Bishop ME, Wilson GT, et al. Classification of eating disorders: toward DSM-V. Int J Eat Disord. Nov 2007;40 Suppl:S123-9. [Medline].

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  5. Bowers WA, Ansher LS. The effectiveness of cognitive behavioral therapy on changing eating disorder symptoms and psychopathology of 32 anorexia nervosa patients at hospital discharge and one year follow-up. Ann Clin Psychiatry. Apr-Jun 2008;20(2):79-86. [Medline].

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Further Reading

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Contributor Information and Disclosures

Author

Tracy A Cushing, MD, MPH, Instructor in Medicine, Department of Emergency Medicine, Harvard Medical School; Attending Physician, Department of Emergency Medicine, Mount Auburn Hospital
Tracy A Cushing, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Ron Waldrop, MD, MS, FAAP, FACEP, CPE, Consulting Staff, Commonwealth Emergency Physicians; Director of Pediatric Quality Care Management, INOVA Loudon Hospital; Adjunct Clinical Professor, Georgetown University School of Medicine
Ron Waldrop, MD, MS, FAAP, FACEP, CPE is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Edward Bessman, MD, Chairman, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University
Edward Bessman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Robert Harwood, MD, MPH, FACEP, FAAEM, Program Director, Department of Emergency Medicine, Advocate Christ Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago College of Medicine
Robert Harwood, MD, MPH, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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