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Medical Parameters for Health

Medical Parameters for Health. Or “What does the doctor do, anyway, and why does she do it that way?”. Laura Koenigs, MD Director, Adolescent Medicine Baystate Children’s Hospital Springfield, MA. Objectives. Describe differential diagnoses of weight loss and vomiting

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Medical Parameters for Health

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  1. Medical Parametersfor Health Or “What does the doctor do, anyway, and why does she do it that way?” Laura Koenigs, MD Director, Adolescent Medicine Baystate Children’s Hospital Springfield, MA

  2. Objectives • Describe differential diagnoses of weight loss and vomiting • Describe techniques for determining ideal body weight • Describe common medical complications of eating disorders

  3. Tasks for Provider • Establish diagnosis • Set parameters for normal weight • Set guidelines for activity • Clarify need for hospitalization • Organize a team

  4. Why is intervening critical?

  5. Irreversible Medical Consequences • Growth retardation • Structural brain changes • Decreased peak bone mass • Loss of dental enamel

  6. Establish Diagnosis

  7. Establish Diagnosis • History • Physical • Laboratory tests • ECG

  8. Differential Diagnosis • Endocrine diseases

  9. Differential Diagnosis • Endocrine diseases • Gastrointestinal diseases • Neurologic diseases • Malignancies • Connective tissue diseases • Chronic infection • Other psychiatric illnesses

  10. Symptoms of Starvation • Cold all the time • Tired • Full easily • Constipated • Sad/ Irritable • Hair changes

  11. Signs of Starvation • Bradycardia • Hypotension • Hypothermia • Lanugo / Balding • Yellow discoloration – hands • Acrocyanosis • Ketosis

  12. Signs of Vomiting • Orthostasis • Parotid Swelling • Subconjunctival hemorrhages • Facial petechiae • Tooth enamel erosion • Russell’s sign • Extremity edema

  13. Medically Stable? • Severe malnutrition (≤ 75% av.) • Heart rate (<45) • Temperature (<96) • Heart dysrthymia • Hypoglycemia • Electrolyte or divalent abnormalities • Orthostasis/ Hypotension

  14. Criteria for Admission • Medical instability • Medical complications of malnutrition • Arrested growth/development • Uncontrolled binging / purging • Acute psychiatric emergencies • Failure of outpatient treatment Society Adol Med Position Paper J Adol Health 2003; 33:496-503

  15. What Should a Person Weigh? • Preadolescent: 11-14% body fat • Adult woman’s body: 20-25% fat • Adult male’s body 8- 11% fat

  16. Determining Weight • Adult woman (≥18 y/o) 100 lbs for first 5 feet 5 lbs per inch over 5 feet Give/take 5-10% • Works best at normal heights

  17. Height & Weight Table For Women

  18. Elbow Breadth for Frame Size

  19. BMI Charts • CDC • Weight divided by height squared • Change with age • Adults NL: 18.5-24.9 kg/M2 • Elite athletes, strength sports - 50th% BMI

  20. OK135S060

  21. OK135S069

  22. Sample Child • 12 year old girl • 4’10” tall 62 pounds • BMI of 13 kg/M2

  23. OK135S060

  24. OK135S060

  25. Sample Child • 12 year old girl • 4’10” tall, 62 pounds • BMI of 13 kg/M2 • Ideal BMI 16.5-20.2 kg/M2 • 79- 96 lbs., 87 lbs. 50th %

  26. OK135S060

  27. Sample Child • 12 year old girl • 4’10” tall, 62 pounds • BMI of 13 kg/M2 • Ideal BMI 15.4-18.0 kg/M2 • 71-87 lbs., 87 lbs. 50th %

  28. Following Patient • Make diagnosis • Established normal weight range • Gather team • Criteria for admission

  29. Following Patient • Orthostatic vital signs • Same scale • Wearing only hospital gown • Post void • Check urine for specific gravity • Check oral temperature after bathroom

  30. Weight Restoration Goals • Outpatient • ½ to 1 lb per week • Inpatient • 2-3 lb per week

  31. Caloric Needs • Basal Metabolic Rate • Going 24/7 • Higher if more muscle • Normal activity • Include growth • Exercise

  32. Basal Metabolic Rate • Child • Higher than adult to include growth • Adult • 10 X weight in pounds

  33. Basal Metabolic Rate vs. Weight

  34. BMR • Goes down with starvation • Goes down with Binge/Purge • Goes up with temperature extremes • Goes up with frequent feedings

  35. Calorie Needs • 25% of a person’s calories should be from fat. • 50 - 60 grams of fat per day = low fat diet.

  36. Dietary Guidelines Not gaining weight? • Not eating enough or • Too much exercise

  37. Anorexia Nervosa & Amenorrhea • 25% Precedes weight loss • 50% Occurs with weight loss • 25% Follows weight loss • BMI < 19 kg/M² • Exercise prior to menarche • Low fat diet.

  38. Birth Control Pills • Osteopenia/Osteoporosis = complication of eating disorder • Birth Control pills have not been shown to help • False sense of security

  39. Review • Diagnosis – r/o medical causes as well as fulfilling DSM-IV • Physician should give parameters • Medical stability • Weight goals • Activity guidelines • Hospitalization guidelines

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