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- 2. AN and BN AN: Body weight maintenance is less than 85% of what is expected Restricting Binge Eating/ purging BN: Reoccurring binge eating habits; lack of control Purging Non-purging BED: Eat within a two hour period an amount that is much larger than most
- 3. Background Client: Paris Marshall (F) Age: 34 Height: 5’8” Weight: 115 lbs (52.27kg) Attorney Lives by herself Family Hx: Hypertension- father Smoker: 1 pack per day
- 4. Patient History Perfectionist Spent a lot of time at the Rec center 1 hr swimming in the morning, 3 miles walking on track after lunch, and 1 hr aerobics in the afternoon Taught how to purge with toothbrush, and use of laxatives/ enemas Continued with increased stress She has not had a menstrual period in over 2 years
- 5. Made an effort to keep weight <120lbs Restricting her intake- the hungrier she was the more determined to not give in Thought that this “self control” would help her in the practice of law Graduated at the top of her class and recruited by the most prestigious law firm where she is trying to make partner.
- 6. Tx: tried to stop restricting her food and purging, but coping mechanism for stress Hospitalized for the weekend- severe dehydration Meds: OTC laxatives every other day Allergies/ intolerance: meat, dairy and “desserts” Admitted: class lost consciousness in exercise
- 7. AN and BN AN: Restricting Binge Eating/ purging BN: Purging Non-purging BED:
- 8. What is her diagnosis? Anorexia Nervosa with binging and purging tendencies BP= 90/60 BMI= 17.53kg/m Hamwi= IBW= 140lbs IBW%=115/140= 82.5% Primary nutrition goal: restoring the patients weight to at least 90% of the expected weight (126lbs)
- 9. PESS statements Inadequate energy intake related to Anorexia Nervosa as evidenced by induced vomiting, laxatives, BMI, 24 hour recall. Distorted beliefs about food related to malnourishment as evidenced by lab values, belief of “bad foods”, and food restriction.
- 10. 24 Hour Recall
- 11. Recommendations Recommended weight gain per week: .5-1lb 1 month: 2-4lbs 3 months: 6-12 lbs 1 year: 20-25 lbs. Energy intake: 30-40kcal/kg of body weight per day
- 12. Lab Values Anemia, bone density test, leukocytopenia, hyponatremia, hypokalemia, bradycardia, hypotension, osteoporosis, primary amennorrhea, Low levels Albumin Potassium Magnesium T3 WBC High levels o Sodium o Glucose o AST o LDH o CPK o Alk phosphate o HDL-C
- 13. Response Metabolic response to starvation Relies on ketones instead of glucose for energy Decreases protein degradation Allows body to function for 2-3 months at a stable level Refeeding Syndrome o Reintroducing the client to carbs the body switches back to relying on glucose for energy o Mineral levels decrease- in greater demand o Result in hemolysis, impaired cardiac function/respiratory function, and death
- 14. Professionals Multidisciplinary team: Primary care physician Oversees the whole process Psychiatrist Emotional therapy Dietitian Nutrition therapy
- 15. Treatment Out patient therapy while IBW% stays at 82.5% Increase calories 500-800kcals in first few weeks; gradual progression Break up into more frequent feedings Don’t use specific numbers Increase nutrient dense food high in protein Eat high kcal foods first Add margarine, butter, sauces and gravies Stress management options Group counseling
- 16. Not purging/ restricting Enjoyable foods, benefits of food Ensure: high calorie(350 calories and 13g of protein) 24 essential vitamins and minerals 25-50% fully recover Don’t “punish” make it fun!
- 17. Monitor Vital signs Food and fluid intake/ output Changes in weight and height Body composition Lab values (protein and minerals) Maintain contact with counselor, dental care (fluoride) Weigh with her back to the scale
- 18. Inpatient Care Regress from 82.5% after 2 weeks Severe electrolyte imbalance or body weight <75% of expected (105lbs) Oral feeds: No enteral or parenteral feedings unless life saving intervention Energy intake 2-3lbs per week
- 19. References Nelms, M., Sucher, K., Lacey, K., Roth, S. L., & Habash, D. (2010). Nutrition therapy and pathophysiology. (2/e ed. p. 269-270). Belmont: Brooks/Cole Pub Co Harvard Medical School. (2012, February 8). Bulimia prognosis. Retrieved from http://www.sparkpeople.com/resource/health_a-z_detail.asp?AZ=74&Page=8 sparkpeople.com. (26 A). Retrieved from http://www.sparkpeople.com/resource/health_a-z_detail.asp?AZ=32&Page=8 Mayo, S. (2012, October 09). Mayo clinic. Retrieved from http://www.mayoclinic.com/health/binge-eating-disorder/DS00608 National eating disorder association. (2005). Retrieved from http://www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/Anorex ia.pdf National Eating Disorders Association. (2005). Bulimia nervosa. Retrieved from http://www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/Bulimi a.pdf Smith, M. (2010). Binge eating disorder. Retrieved from http://www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/BingeE D.pdf The free dictionary. (2011). Retrieved from http://medicaldictionary.thefreedictionary.com/starvation The free dictionary. (2011). Retrieved from http://medicaldictionary.thefreedictionary.com/starvation Metabolic response to starvation metabolic response to starvation metabolic response to starvation . (2002). Retrieved from http://d3jonline.tripod.com/13Metabolism_and_Nutrition/Metabolic_Response_to_Starvation.htm (2010). Binge eating disorder. Retrieved from http://www.mayoclinic.com/health/binge-eatingdisorder/DS00608/DSECTION=treatments-and-drugs Brennan Silva, L. R. (2010, April 20). Retrieved from http://www.fitday.com/ International Dietetic & Nutrition Terminology (IDNT): Reference Manual. Standardized Language for Nutrition Care Process. 2nd ed. Chicago, IL: American Dietetic Association, 2009. Nelms, M. N., Long, S., & Lacey, K. (2008). Medical nutrition therapy, a case study approach. (p. 39, 41-42). Wadsworth Pub Co. http://nspt4kids.com/health-topics-conditions/binge-eating-disorder/ (2011). Retrieved from http://www.avalonhills.org/ (2002). Retrieved from http://renfrewcenter.com/ (2012) http://www.rosewoodranch.com/why-choose-rosewood/meet-our-leadership-team