eMedicine Specialties > Emergency Medicine > Psychosocial

Anorexia Nervosa: Follow-up

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

Follow-up

Further Inpatient Care

  • Patients with anorexia nervosa may require a medical admission if they are extremely ill, have cardiac dysrhythmias, or severe metabolic abnormalities.
  • Most patients will either be admitted to psychiatric facilities both for refeeding and counseling or be managed on an outpatient basis.

Further Outpatient Care

  • Close follow-up with the primary care physician is very important. Patients with anorexia nervosa should have their weight and electrolytes checked within a week of their emergency department visit.
  • Outpatient psychiatric treatment should be arranged as soon as possible from either the emergency department or a primary care referral.

Complications

  • Patients with anorexia nervosa are at risk for complications related to nutritional and electrolyte imbalances, as well as long-term social and interpersonal difficulties due to their disorder.
  • Physiologic complications involve nearly every organ system.
    • Fluid and electrolyte imbalances include hypokalemia, hyponatremia, hypochloremia, metabolic alkalosis, elevated BUN, decreased GFR, and ketonuria.
    • Cardiovascular complications range from bradycardia, orthostatic hypotension, prolonged QT interval, low voltage, and mitral valve prolapse, to frank congestive heart failure and dysrhythmias.
    • Gastrointestinal effects include constipation, bloating, early satiety, parotid gland hypertrophy, delayed gastric emptying, Mallory-Weiss tears, esophageal perforation, fatty liver infiltration, gallstones, and pancreatitis.
    • Hematologic findings include anemia, leukopenia, thrombocytopenia, and impaired immunity.
    • Endocrine problems due to starvation involve growth retardation, delayed puberty, amenorrhea, low T3 level, hypercortisolemia, and diabetes insipidus.
    • Dermatologic complications include acrocyanosis, hypercarotenemia, brittle hair and nails, hair loss, lanugo, and pitting edema.
    • Neurologically, patients may develop peripheral neuropathy, seizures, and cortical atrophy. Psychologically, patients are at risk for isolation, depression, and suicide in addition to their disordered thought patterns regarding food and weight.
  • The process of refeeding must be undertaken slowly, with modest increases in metabolic demands to avoid heart failure and a "refeeding syndrome" including life-threatening dysrhythmias and hypophosphatemia. Ideal weight gain should occur at a rate of 1-2 lb per week.

Prognosis

  • The prognosis for recovery from anorexia nervosa is multifactorial. Overall, the prognosis has not changed much over the past 50 years. In one large meta-analysis, 47% of patients fully recovered; 33% improved somewhat; and 20% developed chronic, relapsing anorexia.
  • Patients with later age at onset of the disorder, binge-purge behavior, and concurrent mood disorders have a worse prognosis for full recovery.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • As with all psychiatric and behavioral emergencies, care must be taken to prove and document competency upon discharge. Many patients with anorexia nervosa may have underlying psychopathology, which leaves them incapacitated during an anorexic crisis. If doubt remains, the patient must be admitted for more thorough psychiatric and physiologic monitoring or discharged in the care of a competent adult.
 


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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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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