Emergent Management of Anorexia Nervosa Workup

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

Approach Considerations

The emergency department workup of a patient with possible anorexia nervosa should include a basic medical evaluation as well as urgent or timely outpatient psychiatric evaluation. If the patient has not been previously diagnosed with anorexia nervosa, a thorough medical evaluation should seek other metabolic or gastrointestinal causes of severe weight loss.

No definitive diagnostic tests are available for anorexia nervosa. However, given the multi-organ system effects of starvation, a thorough medical evaluation is warranted. Basic tests include physical and mental status evaluation, complete blood cell count, a metabolic panel, urinalysis, a pregnancy test in females of childbearing age, and an electrocardiogram (ECG).

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. The serum phosphorus level may be low; levels less than 0.8 mmol/L should be repleted.

Liver function test results may be slightly elevated. Albumin and protein levels are usually normal, however.

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. Thyroid function tests, prolactin, and serum follicle-stimulating hormone levels can differentiate anorexia nervosa from alternative causes of primary amenorrhea.

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.[13, 24]

Imaging studies are rarely necessary in the ED. However, a chest radiograph may reveal rib fractures from repetitive vomiting in the presence of hypocalcemia. Patients may also show evidence of osteopenia. Radiographic evidence of emphysematous changes is present on the chest CT scan of patients with anorexia[25] ; however, these changes resolve with refeeding and weight normalization, unlike those seen in chronic obstructive pulmonary disease.

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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.

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