Emergent Management of Anorexia Nervosa Medication

  • Author: Ron D Waldrop, MD, MS, FAAP, FACEP, FACPE; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Jun 17, 2011
 

Medication Summary

Medical therapy in the emergency department consists of electrolyte repletion and stabilization. Multiple studies have failed to show an overall benefit for pharmacologic treatment of anorexia nervosa with psychiatric medications. However, most patients who recover will be treated with a multidisciplinary approach that includes medication, psychotherapy, nutritional counseling, and frequent medical evaluations.[26, 27]

The most common class studied is selective serotonin reuptake inhibitors (SSRIs), which have been shown to be beneficial in patients with bulimia nervosa but not anorexia. However, since many patients with anorexia have concurrent mood disorders, medication may be of benefit.

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Electrolytes

Class Summary

Electrolyte repletion is necessary in patients with profound malnutrition, dehydration, and purging behaviors. Repletion may be done orally or parenterally, depending on the patient’s clinical state.

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Potassium chloride

 

Potassium is essential for transmission of nerve impulses, contraction of cardiac muscle, maintenance of intracellular tonicity, skeletal and smooth muscles, and maintenance of normal renal function. Gradual potassium depletion occurs via renal excretion or GI loss or because of low intake. Depletion usually results from diuretic therapy, primary or secondary hyperaldosteronism, diabetic ketoacidosis, severe diarrhea (if associated with vomiting), or inadequate replacement during prolonged parenteral nutrition.

Potassium depletion sufficient to cause 1 mEq/L drop in the serum potassium level requires a loss of approximately 100-200 mEq of potassium from the total body store.

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Calcium gluconate

 

Calcium gluconate moderates nerve and muscle performance and facilitates normal cardiac function. It can be given IV initially, and then calcium levels can be maintained with a high-calcium diet. Some patients require oral calcium supplementation. The 10% IV solution provides 100 mg/mL of calcium gluconate that equals 9 mg/mL (0.46 mEq/mL) of elemental calcium. One 10-mL ampule contains 93 mg of elemental calcium

Potassium phosphate

 

For severe hypophosphatemia (< 1 mg/dL), parenteral preparations of phosphate should be used for repletion. IV preparations are available as sodium or potassium phosphate (K2PO4). Response to IV serum phosphorus supplementation is highly variable and is associated with hyperphosphatemia, and hypocalcemia. The rate of infusion and choice of initial dosage should be based on severity of hypophosphatemia and presence of symptoms. Serum phosphate and calcium should be monitored closely.

For less severe hypophosphatemia (1-2 mg/dL), PO phosphate salt preparations can be used. PO preparations are available as sodium or potassium phosphate in capsule or liquid form. Neutra-Phos packets contain 250 mg of phosphorus/packet. Tablets contain 250, 125.6, or 114 mg each. Liquid preparations are available as 250 mg/75 mL.

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Contributor Information and Disclosures
Author

Ron D Waldrop, MD, MS, FAAP, FACEP, FACPE  Emergency Physician, Commonwealth Emergency Physicians; Director of Pediatric Quality Care Management, Inova Loudoun Hospital; Adjunct Clinical Professor, Georgetown University School of Medicine

Ron D Waldrop, MD, MS, FAAP, FACEP, FACPE is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Tracy A Cushing, MD, MPH, FACEP, FAWM  Assistant Professor, Department of Emergency Medicine, University of Colorado School of Medicine; Attending Physician, Denver Health Medical Center

Tracy A Cushing, MD, MPH, FACEP, FAWM 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.

Specialty Editor Board

Edward Bessman, MD  Chairman, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

Chief Editor

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of Siobhan O'Herron, MD,to the development and writing of the source article.

References

  1. Kaplan H, Sadock B. Fleischer GR, Ludwig S, eds. Synopsis of Psychiatry. 8th ed. Williams and Wilkins; 1998:720-727.

  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Washington DC: American Psychiatric Association; 1994:539-545.

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

  4. Zimmerman M, Francione-Witt C, Chelminski I, Young D, Tortolani C. Problems applying the DSM-IV eating disorders diagnostic criteria in a general psychiatric outpatient practice. J Clin Psychiatry. Mar 2008;69(3):381-4. [Medline].

  5. Forman S. Eating Disorders: epidemiology, pathogenesis, and clinical features. Up to Date [online]. 2005.

  6. Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord. Dec 2003;34(4):383-96. [Medline].

  7. Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. Feb 13 2010;375(9714):583-93. [Medline].

  8. Nilsson EW, Gillberg C, Råstam M. Familial factors in anorexia nervosa: a community-based study. Compr Psychiatry. Nov-Dec 1998;39(6):392-9. [Medline].

  9. Kaye W. Neurobiology of anorexia and bulimia nervosa. Physiol Behav. Apr 22 2008;94(1):121-35. [Medline]. [Full Text].

  10. Sohlberg S, Strober M. Personality in Anorexia nervosa: an update and a theoretical integration. Acta Psychiatr Scand Suppl. 1994;378:1-15. [Medline].

  11. Stoving RK, Hangaard J, Hansen-Nord M, Hagen C. A review of endocrine changes in anorexia nervosa. J Psychiatr Res. Mar-Apr 1999;33(2):139-52. [Medline].

  12. Macias-Robles MD, Perez-Clemente AM, Macia-Bobes C, Alvarez-Rueda MA, Pozo-Nuevo S. Prolonged QT interval in a man with anorexia nervosa. Int Arch Med. Jul 31 2009;2(1):23. [Medline]. [Full Text].

  13. Vazquez M, Olivares JL, Fleta J, Lacambra I, Gonzalez M. [Cardiac disorders in young women with anorexia nervosa]. Rev Esp Cardiol. Jul 2003;56(7):669-73. [Medline].

  14. Morse JL, Safdar B. Acute tension pneumothorax and tension pneumoperitoneum in a patient with anorexia nervosa. J Emerg Med. Apr 2010;38(3):e13-6. [Medline].

  15. Verhoef PA, Rampal A. Unique challenges for appropriate management of a 16-year-old girl with superior mesenteric artery syndrome as a result of anorexia nervosa: a case report. J Med Case Reports. Nov 16 2009;3:127. [Medline]. [Full Text].

  16. Becker AE, Grinspoon SK, Klibanski A, Herzog DB. Eating disorders. N Engl J Med. Apr 8 1999;340(14):1092-8. [Medline].

  17. Bochereau D, Clervoy P, Corcos M, Girardon N. [Eating disorders. Anorexia nervosa in adolescents]. Presse Med. Jan 16 1999;28(2):89-99. [Medline].

  18. Lavelle JM. Adolescent emergencies. In: Fleischer GR, Ludwig S, eds. Textbook of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins; 1993:1503-1526.

  19. 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].

  20. Steinhausen HC. The outcome of anorexia nervosa in the 20th century. Am J Psychiatry. Aug 2002;159(8):1284-93. [Medline].

  21. Crow SJ, Peterson CB, Swanson SA, Raymond NC, Specker S, Eckert ED. Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry. Dec 2009;166(12):1342-6. [Medline].

  22. Sylvester CJ, Forman SF. Clinical practice guidelines for treating restrictive eating disorder patients during medical hospitalization. Curr Opin Pediatr. Aug 2008;20(4):390-7. [Medline].

  23. Altinyazar V, Kiylioglu N, Salkin G. Anorexia Nervosa and Wernicke Korsakoff's Syndrome: Atypical Presentation by Acute Psychosis. Int J Eat Disord. 2010.

  24. Miller KK, Grinspoon SK, Ciampa J, Hier J, Herzog D, Klibanski A. Medical findings in outpatients with anorexia nervosa. Arch Intern Med. Mar 14 2005;165(5):561-6. [Medline].

  25. Coxson HO, Chan IH, Mayo JR, Hlynsky J, Nakano Y, Birmingham CL. Early emphysema in patients with anorexia nervosa. Am J Respir Crit Care Med. Oct 1 2004;170(7):748-52. [Medline].

  26. Reinblatt SP, Redgrave GW, Guarda AS. Medication management of pediatric eating disorders. Int Rev Psychiatry. Apr 2008;20(2):183-8. [Medline].

  27. Rosenblum J, Forman S. Evidence-based treatment of eating disorders. Curr Opin Pediatr. Aug 2002;14(4):379-83. [Medline].

 
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