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MARSIPAN – Management of Really Sick Patients with Anorexia Nervosa

MARSIPAN – Management of Really Sick Patients with Anorexia Nervosa. Royal College of Psychiatrists and Royal College of Physicians – Oct 2010. Why written?. AN patients on general medical wards don’t always do very well Some confusion over respective roles

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MARSIPAN – Management of Really Sick Patients with Anorexia Nervosa

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  1. MARSIPAN – Management of Really Sick Patients with Anorexia Nervosa Royal College of Psychiatrists and Royal College of Physicians – Oct 2010

  2. Why written? • AN patients on general medical wards don’t always do very well • Some confusion over respective roles • Guidance to primary care over when to refer (no GP on task group)

  3. Recognition and awareness • “Patients with anorexia nervosa can seem deceptively well – they may have an extremely powerful drive to exercise which sometimes seems to override their lack of nutritional reserve...” • Patients can deteriorate very quickly. • Any patient with weight loss with or without amenorrhoea may have AN, especially of there are signs of weight preoccupation, lack of concern about weight loss or compensatory behaviours such as vomiting. • Differential diagnosis includes depression and infectious mononucleosis.

  4. BMI Anorexia <17.5 – consider referral; if <15 urgent referral Medium risk 13-15 High risk <13 Physical examination Low pulse, BP, core temperature Muscle power reduced SUSS (sit up – squat – stand) Blood tests Sodium low: suspect water loading (<125 = high risk) Potassium low: vomiting or laxative abuse (<3 = high risk) (low Na and K can occur anyway in malnutrition) Raised transaminases Hypoglycaemia: blood glucose <3 (suspect occult infection, esp if low albumin or raised CRP ECG – if BMI <15 Bradycardia Raised QTc (>450ms) Nonspecific t-wave changes Hypokalaemic changes Observations and tests

  5. Refeeding • Rapid re-feeding may precipitate electrolyte changes – would need daily bloods (no GP on the panel…)

  6. Compulsory admission and treatment • Presence of a mental disorder (e.g. anorexia) • In-patient treatment is appropriate (for re-feeding) • The condition presents a risk to the health and safety of the patient “Under the MHA, feeding is recognised as treatment for anorexia nervosa and can be done against the will of the patient as a life-saving measure.”

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