January Week 3: Eating Disorders

Case One:
A 14 y.o female is brought to you by her mother with concern for weight loss. Her mom believes the teen has lost ~30 lbs in the past year after going on a “diet” when she became interested in trying out for the cheerleading squad. Mom was supportive with the weight loss initially but feels her daughter is now obsessed with calorie counting and weighs herself several times a day. She recently has started to refuse to eat dinner with the family.

1. What further history would you need to elicit in order to make the diagnosis of anorexia nervosa or bulimia nervosa? (according to the DSM-IV criteria)
2. During your physical exam, what findings would be consistent with that of an eating disorder?
3. What are other conditions that may cause significant weight loss? What would you include in your initial work-up (i.e. screening labs) for this pt?
4. You discover during your history-taking that her LMP was ~7 mo ago. What is she particularly at high risk for? How will you diagnose this possibility?
5. Upon completion of your H&P and initial lab work-up, you deem her stable for outpatient management. What guidelines will you recommend for home? What types of therapy may be particularly helpful?

Case Two:
A 15 y.o. girl is hospitalized because of anorexia nervosa, with a BMI at 70% of ideal body weight.

1. What are other criteria for hospitalization?
2. What is the goal for her daily weight gain? What is a typical inpatient meal plan for pts with significant eating disorders?
3. Tube feedings are ultimately initiated for this patient because she continues to make inappropriate meal choices. What is she at risk for during the reintroduction of food? What supplement is she most likely to require?

Pediatrics in Review-December 2011. “Eating Disorders”