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Medical Monitoring: Routine Check-up
Medical Monitoring: Body Systems
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Medical Monitoring: Routine Check-up

Routine monitoring is necessary to ensure medical stability

Eating disorders can have significant medical complications and in severe cases can result in death. 

The frequency of appointments will change depending on the stage and severity of illness.  

Be flexible and be prepared to adapt to the person’s needs. 

Weekly appointments are necessary when: 

  • The person requires inpatient care (but cannot/has not been admitted) 
  • The illness is acute or chronic 
  • There are rapid changes in condition 
  • The patient is a child (prone to rapid deterioration)

Fortnightly or monthly appointments are appropriate when: 

  • A treatment team has been established, and 
  • The person’s condition is more stable 

See below for medical investigations:

  1. Routine Medical Check-Up
  2. Rapid Risk Assessment Physical Examination
  3. Long-term Medical Investigations
  4. To be undertaken at follow up appointments

Rapidly Assess Risk

Heart

  • SOB
  • Chest pain
  • Palpitations
  • Syncope
  • Oedema

Endocrine

  • Menstruation
  • Cold Sensitivity

Food intake

  • Current intake and recent changes
  • Presence of food rules
  • Compensatory behaviours (i.e. binge/purge, laxatives, exercise)

Weight

  • Sensitively discuss weight loss or fluctuations

Concern of loved ones

  • Ask: "Has anyone been worried about you?"
  • Any concern a family member or carer has should be taken seriously

Physical Exam

BP/HR

  • Lying and Standing (after 2 minutes)

Temperature

  • Check for hypothermia

General Appearance

  • E.g. skin, hydration, circulation, self-harm, parotids, dentition, etc.
  • UA (for SG)
  • Consider MSU (for SG)

Weight & Height (if appropriate)

  • Use sensitively (i.e. give option to blind weigh, make it quick and easy)

Bloods

  • "New ED" - FBC, ESR/CRP, E/LFT CMP, E/P/LH/FSH, BSL, Iron B12, Folate, Zinc, TSH/TFT
  • Consider coeliac serology, amylase, chol/trigs, if indicated
  • "Routine ED" - FBC E/LFT BSL CMP

ECG

  • Rate
  • QTc

Longer term medical investigations

After the initial assessment, more comprehensive medical investigations can be undertaken at follow up appointments. 

Work your way through these investigations at a pace that works for you and your patient. 

Brain

Short term

  • Confusion, drowsiness, seizures, poor memory and concentration
  • Depression, anxiety, and OCD
  • Insomnia (anxiety vs hunger keeping awake)

Growth trajectory/charts in young people

Refer to the below resources:

  • Healthy Weight for Kids
  • Growth Charts & Goal Weight

ENT

  • Parotid swelling
  • Dental (tooth and gum disease from malnutrition, caries from purging)

Endocrine

  • Amenorrhoea
  • Sick euthyroid
  • Poor temperature regulation
  • Hypoglycaemia
  • Osteoporosis

Cardiovascular

  • Arrhythmia, long QTc
  • Long term: oedema, heart failure

GIT

  • Decreased gastric mobility
  • Bloating
  • Constipation
  • Dysphagia
  • Pancreatitis (scope if purging >5 years)

Bone Marrow

  • Low WCC
  • Anaemia (chronic disease or iron def)
  • Thrombocytopaenia
  • Immune response to infection

GP Dr Jan Orman discusses the importance of routinely monitoring the person's psychological wellbeing, as well as their physical wellbeing.

Medical Complications

Medical Complications of Anorexia Nervosa

Journal of Eating Disorders

Medical Complications of Bulimia Nervosa

Journal of Eating Disorders

CEED Medical Monitoring in Eating Disorders resource

The Victorian Centre of Excellence in Eating Disorders