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A 14 year old girl is brought in by her parents because of concerns that she is “too thin.” The girl feels that she is not too thin (and, if anything, is a little “chubby”), and that she eats plenty, but says she tries to eat “healthy.” Per her parents, she exercises 2 hours per day. Vital signs in the ED are: temperature 95.8 oral, HR 55, RR 18, BP 88/40. Her BMI is 15, and her weight is 73% of her ideal body weight. Her mental status is normal. Her capillary refill is < 2 seconds. An ECG is performed and is normal.
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April 16, 2019 at 4:02 pm
A) Admit for inpatient evaluation and management
This patient’s presentation is consistent with an eating disorder, likely anorexia nervosa. AAP criteria for inpatient hospitalization include: HR < 50 daytime < 45 nighttime, SBP 10 mm Hg or HR change > 20 bpm, arrhythmia on ECG, Temp < 96 F, < 75% ideal body weight, body fat < 10%, refusal to eat, and failure to respond to outpatient therapy. Criteria for inpatient admission for bulimia nervosa include: syncope, serum K < 3.2, serum Cl < 88, esophageal tear, arrhythmia (including long QTc), hypothermia, suicide risk, intractable vomiting, hematemesis, and failure to respond to outpatient therapy.