Ver el código de «Anorexia nervosa»

==Background==
*Associated with body image disturbance
*Usually seen in adolescent girls
**3rd most common chronic condition in adolescent girls
**Life long risk
*Body image is predominate measure of self worth
*Mortality 6-20%, highest of any psychiatric disorder

==Clinical Features==
[[File:Anorexia case-1900-Nouvelle icononographie de la Salpetriere.jpg|thumb|Patient with anorexia nervosa.]]
===Diagnostic Criteria===
#Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical  health. Significantly low weight is  defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. <ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>
#Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
#Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

===Symptoms===
*[[Constipation]]
*[[Abdominal pain]]
*Fatigue
*[[Weakness]]
*Amenorrhea
*[[Depression]]
*Hair loss

===Signs===
*Fine facial and body hair (lanugo)
*Brittle hair and nails
*Dry, scaly skin
*Loss of subcutaneous fat
*Breast and vaginal atrophy

===Associated conditions===

==Differential Diagnosis==
*Gastrointestinal disease
*[[Hyperthyroidism]]
*Occult malignancies
*[[AIDS]]
*Major depressive disorder
*[[Schizophrenia]]
*[[Substance abuse]]
*Social [[anxiety]] disorder
*Obsessive-compulsive disorder
*[[Bulimia nervosa]]

==Evaluation==
*Exclude: Inflammatory bowel disease, hyperthyroidism, chronic infection, diabetes mellitus, and Addison’s disease<ref>John F. Bober, Scott E. Moser: Rakel: Textbook of Family Medicine, 8th ed., Saunders, 2011 (Ch)24: p452</ref>
*CBC
**[[Anemia]], [[leukopenia]] in severe disease
*Chem 10
**[[Hypoglycemia]], [[hypophosphatemia]] in severe disease
*[[ECG]]

==Management== 
*Treat medical complications<ref>https://pedemmorsels.com/eating-disorders/</ref>
**Cardiovascular
***[[Bradycardia]] due to increased vagal tone
***Other serious [[dysrhythmias]]
***Decreased cardiac muscle from malnutrition --> cardiac dysfunction, [[mitral valve prolapse]]
***Caution with rate of [[IVF]] (risk of [[pulmonary edema]])
**Fluid/Electrolytes
***Serious [[electrolyte abnormalities]] can occur
****[[Hypophosphatemia]] can impair cardiac and diaphragmatic muscle contractions--> [[respiratory arrest|respiratory]]/[[cardiac arrest]]
****[[Hypomagnesemia]], [[hypokalemia]] and alterations with refeeding can cause [[arrhythmia]]
***[[Refeeding syndrome]] risk
***Even 1L of d5 NS could harm patient subsisting on <400kcal daily
**Gastrointestinal
***Delayed gastric/colonic emptying--> [[gastroparesis]], distension, [[GERD]], [[constipation]], [[SMA syndrome]]
**MSK
***Osteoporosis due to HPA dysfunction
***Risk of fracture with minimal or no trauma
*Must avoid use of [[bupropion]] as it may lead to seizures in patients with eating disorders

==Disposition==
*Inpatient management for:
**Extremely low weight (<75% of expected body weight) or rapid weight loss
**[[Hypotension]] (<80/50 mmHg)
**[[Hypothermia]] (<96 degrees F)
**Severe [[electrolyte imbalances]]
**Cardiac disturbances
**[[Bradycardia]] <50
**Acute medical disorders
**Severe or intractable purging
**Psychosis or a high risk of [[suicide]]

==Also See==
*[[Bulimia nervosa]]
*[[General psychiatric workup]]

==References==
<references/> 

[[Category:Psychiatry]] [[Category:Pediatrics]]