Pediatric Anorexia Nervosa Workup

  • Author: Bettina E Bernstein, DO; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Jan 18, 2012
 

Approach Considerations

Because an eating disorder is a clinical diagnosis, no specific diagnostic tests are available. However, some laboratory tests may be appropriate to evaluate for the effects of anorexia nervosa on the patient's organ systems, as briefly reviewed in the next section.

Go to Emergent Management of Anorexia Nervosa and Bulimia Nervosa for complete information on these topics.

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Laboratory Evaluation

The following studies are generally used in assessing patients with anorexia nervosa.

CBC and ESR

Obtain a complete blood cell (CBC) count with erythrocyte sedimentation rate (ESR). The hemoglobin levels are typically normal, although elevations are observed in states of dehydration. If anemia is observed, it is not due to menstrual blood loss, as these patients are usually amenorrheic. In such cases, further investigation is warranted.

The white blood cell (WBC) count is typically low due to increased margination, and thrombocytopenia is also observed. The leukopenia is not a sign that the patient is at an increased risk for infection.

The ESR is normal. Elevations should prompt a search for an organic etiology (see Differentials).

Blood chemistries

Hyponatremia reflects excess water intake or the inappropriate secretion of antidiuretic hormone (ADH). Hypoglycemia results from the lack of glucose precursors in the diet or low glycogen stores. Low blood glucose may also be due to impaired insulin clearance.

The renal function is generally normal except in patients with dehydration, in whom the blood urea nitrogen (BUN) level may be elevated. Also perform a urinalysis.

A hypokalemic hypochloremic metabolic alkalosis is observed with vomiting, and acidosis is observed in cases of laxative abuse.

Protein and albumin levels are surprisingly normal because, although the amount of food intake is restricted, it usually contains high-quality proteins.

Serum vitamin D and calcium levels may be helpful, especially if osteoporosis is suspected and should always be obtained if a trial of bisphosphonates is attempted for confirmation.[19, 57]

Liver function studies

Liver function test results are minimally elevated, but levels encountered in patients with active hepatitis are not observed.

Dramatic cholesterol elevations are observed in cases of starvation. This elevation may be secondary to the following: (1) a decrease in triiodothyronine (T3) levels, (2) low cholesterol binding globulin levels, and (3) leakage of intrahepatic cholesterol.

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Electrocardiography

Cardiovascular complications account for most of the morbidity and mortality associated with anorexia nervosa, as previously discussed in the Complications section under Prognosis.

An electrocardiogram (ECG) is helpful in evaluating for a prolonged QT interval. ECG findings may include low voltage, prolonged QTc, and nonspecific T-wave changes.[52] In patients taking drugs with a prolonged QT, potential harmful dysrhythmias are possible.

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Contributor Information and Disclosures
Author

Bettina E Bernstein, DO  Clinical Assistant Professor, Department of Psychiatry, Philadelphia College of Osteopathic Medicine; Private Practice at the Wynnewood House; Outpatient Consultant, Clinical Affiliate, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia; Court Appointed Evaluator, Family Court of Philadelphia; Psychiatric Consultant, Intercommunity Action, Inc, Easttown Tredyffrin School District

Bettina E Bernstein, DO is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry and American Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Angelo P Giardino, MD, PhD, MPH  Associate Professor, Baylor College of Medicine; Chief Medical Officer, Texas Children's Health Plan; Chief Quality Officer, Medicine, Texas Children's Hospital

Angelo P Giardino, MD, PhD, MPH is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, Helfer Society, and International Society for Prevention of Child Abuse and Neglect

Disclosure: Bayer Honoraria Review panel membership; Pfizer Grant/research funds Independent contractor; MedImmune Honoraria Review panel membership; Teva Pharmacutical travel & honoraria Managed Care Advisory Panel; CIGNA Honoraria Physician Advisory Council

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Jennifer DA Liburd, MD, to the development and writing of the source article.

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