Adolescence
Box 31.1
Medical complications of eating disorders
Medical complications of calorie restriction
•
Cardiovascular: ECG abnormalities — bradycardia; T-wave inversion; ST segment depression;
prolonged Q-T interval; dysrhythmias (SVT, VT); pericardial infusions
•
Gastrointestinal system: delayed gastric emptying; slowed GI motility; constipation;
bloating; fullness; hypercholesterolaemia; abnormal liver function (carotenaemia)
•
Renal: increased blood urea (from dehydration and reduced GFR) with increased risk of renal
stones; polyuria (from abnormal ADH secretion); depletion of Na and K stores; peripheral
oedema with refeeding due to increased renal sensitivity to aldosterone
•
Haematology: leucopenia; anaemia; iron deficiency; thrombocytopenia
•
Endocrine: sick thyroid syndrome (low T
3
); amenorrhoea; growth failure; osteopenia
•
Neurological: cortical atrophy; seizures
•
Death
Medical complications of purging
•
Fluid and electrolyte imbalance: low K; low Na; low Cl
•
Chronic vomiting: oesophagitis; dental erosions; oesphageal tears; rarely rupture and
pneumonia
•
Use of ipecac/laxatives: myocardial damage; renal stones; low Ca; low Mg; low KCO
3
•
Amenorrhoea
Assessment
The purpose of assessment is to clarify the diagno-
sis, undertake a risk assessment, assess the impact
of the problem on the young person’s develop-
ment and general functioning and the functioning
of the family, consider treatment expectations and
motivation, and observe family relationships and
communication, to reach an understanding (for-
mulation) of the problem with the young person
and their family. Assessment also serves to engage
the young person and their family, whose moti-
vations for seeking help may be very different.
Many young people are brought to treatment, and
the egosyntonic nature of eating disorders is such
that consent (or assent) to treatment cannot be
assumed, but needs to be balanced against acting
in the best interests of the child, and the responsi-
bilities, rights and duties of parents to provide, in
a manner consistent with the evolving capacities
of the child, appropriate direction and guidance.
If necessary, formal legal frameworks surround-
ing child welfare or mental health may need to
be invoked, but a collaborative and motivational
stance is likely to minimize the need for this except
in rare situations.
Medical aspects
Medical complications of eating disorders can be
a result of calorie restriction leading to weight
loss, poor nutrition or purging behaviours [14].
Box 31.1 summarizes the complications of eating
disorders, some of which are short term and some
long term. Figure 31.1 shows why body mass
index is inappropriate in children and adolescents.
In adolescents, degree of underweight is best
expressed as percent BMI/median BMI for age
and gender (also known as weight for height).
Using this terminology, less than 85% BMI would
be considered underweight, and less than 70%
BMI would indicate severe malnutrition. Weight
alone is not adequate to assess medical risk, how-
ever. Table 31.3 outlines the risk parameters that
require assessment, and when to be concerned.
Acute malnutrition is a medical emergency.
In adolescents, assessment of pubertal devel-
opment is important for determining risk for
complications such as growth retardation and
Do'stlaringiz bilan baham: |