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Medical Monitoring: Body Systems

Medical investigations

Medical investigations will need to be tailored to the individual complaints and needs of the person.

Remember: FOOD IS MEDICINE and is the most important treatment available for these conditions.

However, the following may be applicable:

Brain

Watch out for:

Eating disorders commonly co-occur with:

Anxiety/Depression/OCD
Emergence of OCD symptoms at low weight
Personality disorders/AOD/Trauma
Suicidality
Pseudo atrophy of brain in long term illness

Quick tips:

Ensure these are addressed as part of treatment plan
Develop a safety plan
Medication - generally not indicated but can be useful for co-morbidities
Mindfulness-based activities to calm the system
Relaxation/Mediation/Yoga (ED-informed)

Heart

Watch out for:

Arrhythmia - esp. hypoglycaemia, long QTc
Electrolyte disorders esp K, Mg, PO4
Postural hypotension and bradycardia

Quick tips:

ECG and bloods - check the (likely) impact of anything you prescribe on QT interval
Postural BP and HR measurements
Monitor carefully: Medications, fluid intake, regular eating
Monitor electrolyte levels during refeeding esp K, PO4, Mg
Electrolyte replacements and thiamine
Save Exercise at Every Size guidelines for exercise

Gastrointestinal

Watch out for:

Bloating - delayed gastric emptying
Abdo pain mimicking IBS
Constipation
Abnormal LFTs (can be starvation or refeeding)

Quick Tips:

Maxalon/motilium (watch dose)
Buscopan/Antacids/PPI
Probiotics can be explored
Osmotic laxatives only (osmolax/movicol)
Lying on right side after meals

Note: these symptoms can be serious roadblocks to recovery and deserve full attention and consideration.

Endocrine

Watch out for:

Hypothalamic amenorrhea
Sick euthyroid syndrome - thyroid hormone abnormalities that do not require specific treatment
Osteopaenia/osteoporosis and fractures

Quick tips:

BMD
Consider MHT - topical E2 even if young
Optimise Ca and Vit D
Consider contraception and sexual health needs

Refeeding syndrome

Definition	Dangerous fluid and electrolyte shifts that can happen suddenly with re-nourishment. Refeeding syndrome can be prevented.
Incidence	Lower in outpatient settings, low in expert inpatient settings
Cause	Rapid insulin rise pulls phosphate into cells
Watch out for	Oedema Confusion (Wernicke's) Muscle weakness (aches and pains) and breathlessness (CCF)
Monitoring	Regular bloods esp EUC and CMP, may need to be 2-3 times a week to start Check baseline albumin as this can be predictive Baseline ECG
Quick tips	Frequent clinical observations and biochemical review depending on starting clinical status and progress Consider prescribing oral thiamine and phosphate (thiamine is needed in high metabolism and glucose intake) Consider multivitamin and zinc For oedema: Reassure will settle 1-2 weeks, elevate legs, compression stockings, watch salt/fluid/carb proportions with dietician input.

Haematology

Watch out for:

Anaemia and iron deficiency
WCC changes - bone marrow suppression
B12 folate and platelet abnormalities

Quick tips:

Don't over investigate
Watch immunity especially bacterial
Nourish and supplement as appropriate
Watch for hypophosphataemia if doing iron infusion!
Ensure appropriate vaccinations

Skin

Watch out for:

Skin changes
Dry skin
Hair loss

Quick tips:

Watch zinc
Emollients

Dental

Watch for	Dental erosion and caries
What to do	Regular dental review Rinse with water after purging Do not brush teeth for a couple of hours afterwards Utilise "Tooth Mousse Plus" product on teeth (esp back surface of top teeth) to remineralise - can use daily or more often

Sleep Disturbances

What to do

Morning sunlight
Sleep routine
Adequate food intake throughout the day and before bed

Parotids

Watch for	Enlargement of the salivary glands due to purging
What to do	How to relieve pain

Sexual Health

What to do

Consider contraceptive needs