Medical Management of Severe Eating Disorders

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Medical Management of Severe Eating Disorders

• By The Doctor Weighs In

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Introduction

• Severe eating disorders are the only mental
  illnesses regularly accompanied by dangerous,
  life-threatening medical complications.
  Significant medical instability results from a
  number of abnormalities, such as progressive
  malnutrition, purging behaviors, and blood
  chemistry abnormalities.
• In fact, the disorder can compromise virtually
  all of the bodys vital organs and systems.
• There are a number of different eating disorders
  that lead to excessive weight loss and associated
  medical complications.
• Related contentWhat You Need to Know About
  Eating DisordersEating Disorders Risk Factors,
  Diagnosis, Treatment, and Outcomes

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Medical Complications of Severe Eating Disorders
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Medical Complications of Eating Disorders Can Be
Treated Effectively

• The good news is that nearly all medical
  complications of eating disorders can completely
  resolve with safe nutritional rehabilitation and
  weight restoration. This is true regardless of
  how extensive they are.

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Many Patients with Severe Eating Disorders will
Require a High Level of Care

• More than one-third of individuals suffering from
  eating disorders will require treatment at a
  higher level of care. This can range from 24-hour
  inpatient psychiatric care to comprehensive
  daytime behavioral programming. 
• Most treatment programs offer some degree of
  minimum internal medicine and/or nursing support
  to manage medical issues of eating disorders.
  However, some patients may be so medically
  compromised by their illness that they require
  specialized medical, hospital-based stabilization
  prior to entering a residential eating disorder
  treatment program.

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Determining The Appropriate Level of Care Needed

• It is not uncommon for patients, families, and
  providers to begin with the least intensive
  intervention. However, starting a treatment plan
  with the appropriate level of care can have a
  significant impact on the patients health. It is
  also a factor that influences success in recovery
  and satisfaction with treatment.
• The American Psychiatric Association (APA) has
  outlined five levels of psychiatric care. They
  are divided between outpatient and inpatient
  treatments.

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Weight Specific Recommendations to Levels of Care

• It is important to remember that no guideline is
  absolute when it comes to these complex
  illnesses. The frequency of purging behaviors and
  other physical or psychiatric symptoms must be
  considered alongside patient weight to ascertain
  the appropriate level of care that may be needed.

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What is Inpatient Medical Stabilization for
Eating Disorders?

• In general, initial medical stabilization in a
  hospital-based unit is recommended for eating
  disorder patients who are severely low weight,
  seriously medically compromised, or at risk for
  major complications from refeeding syndrome. The
  latter is a dangerous metabolic disturbance that
  can occur when nutritional rehabilitation is
  first initiated.
• Patients with any/all of the following criteria
  may require medical treatment from experienced
  providers in a specialized medical hospital unit
  before entering a behavioral treatment program in
  a traditional eating disorder unit.

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What is The Goal of Medical Stabilization of
Patients with Severe Eating Disorders?

• The goals of medical stabilization are to improve
  and normalize the patients vital signs,
  cardiovascular system, and bowel function as well
  as restore levels of key electrolytes including
  phosphorus, potassium, magnesium, and calcium in
  a timely manner. Medical stabilization also
  involves nutritional rehabilitation to support
  weight restoration.
• Most experts agree that careful caloric
  initiation is vital to medical stability and
  improved cognitive function. It is hallmarked by
  the ability to tolerate and complete the most
  basic activities of daily living. Inpatient
  medical units have the expertise and resources to
  deliver any form of nutrition required, including
  oral, enteral, or intravenous calories.

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Understanding The Difference Between Medical and
Psychiatric Treatment

• It is also important that providers, patients,
  and families understand the difference between
  inpatient psychiatric treatment and inpatient
  medical stabilization for the most severe eating
  disorders.
• While an inpatient psychiatric facility offers
  round-the-clock behavioral treatment and likely
  some degree of medical support, an inpatient
  medical stabilization program requires a
  hospital-based telemetry unit.
• Its full-time internal medicine physicians,
  nurses, dietitians, and skilled rehabilitation
  providers expertly treat any life-threatening
  medical complication of severe eating disorders.
  These medical teams collaborate with
  psychiatrists, psychologists, and behavioral
  health technicians to support behavioral recovery.

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Avoiding Refeeding Syndrome

• Increasing caloric intake quickly in individuals
  with severe anorexia nervosa or ARFID, without
  frequent monitoring of blood tests and
  electrolyte replenishment, can lead to refeeding
  syndrome. A dangerous shift in fluids and
  electrolytes within the body are characteristic
  of the disorder.
• It occurs in a small subset of patients when
  calories are introduced quickly, lab tests are
  not checked frequently, and resultant
  abnormalities are not treated in a timely
  fashion. The lower the patients BMI, the greater
  the risk of refeeding complications.

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Eating Disorder Patients with Normal or High BMI

• Assuming that patients with a normal or
  higher BMI are always stable enough to access
  lower levels of care may inadvertently cause
  harm. Some of these patients may present with a
  falsely elevated weight.
• They can also be at risk for dangerous
  complications due to excessive purging behaviors
  followed by abrupt cessation or significant and
  rapid weight disruption that is marked weight
  loss over a short period of time.

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The Bottom Line on The Management of Severe
Eating Disorders

• Eating disorders at any stage are complex and can
  be life-threatening. Seeking treatment for a
  severe eating disorder can be overwhelming.

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Get in Touch
The Doctor Weighs In Author Philip Mehler, MD,
FACP, FAED, CEDS Click Here To Read The Full
Article https//thedoctorweighsin.com/medical-man
agement-severe-eating-disorders/ Website
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