ABSTRACT: Anorexia nervosa (AN) is associated with marked decreases in caloric intake and a corresponding reduction in body weight due to abnormal self-body image. Although counterintuitive, hypoalbuminemia and vitamin deficiencies are not expected consequences of this disorder. Etiologic considerations for hypoalbuminemia are discussed.
ABSTRACT: Anorexia nervosa is a chronic eating disorder which often has a poor prognosis. The likelihood of success in treating this disorder, which most commonly strikes females in their prime of life, is greatly enhanced by the attainment of ideal body weight during the refeeding-weight restoration process.
We read with interest Roche and colleagues’ article1 demonstrating normalization of QT dynamicity and measures of heart rate variability (HRV) with refeeding in anorexia nervosa (AN).
Use of Total Parenteral Nutrition in the Refeeding of Selected Patients with Severe Anorexia Nervosa
ABSTRACT: At present there is no consensus on how to refeed patients with severe anorexia nervosa. In these case reports, we describe two patients beset with gastrointestinal comorbidities which impaired their ability to refeed with a staged oral feeding program.
ABSTRACT: Anorexia nervosa is a psychiatric disorder characterized by abnormal eating behaviors that results in weight loss and has serious potential medical consequences. Most of these complications are readily treatable if diagnosed and attended to early in the course of the illness. In caring for patients with anorexia nervosa, the primary care physician has several critical roles.
ABSTRACT: At present there is no consensus on how to refeed patients with severe anorexia nervosa. Staged progressive oral feeding programs, enteral feedings and total parenteral nutrition have been utilized to facilitate recovery.
ABSTRACT: Anorexia nervosa is a challenging disorder to treat, both from a medical and a psychiatric standpoint. Part of the clinical difficulty is based on the patient's ardent desire to resist meaningful weight restoration, and the debilitating fear of food which defines this disorder. However, there are also litanies of medical complications which can interfere with the refeeding process and…
ABSTRACT: To systematically review the evidence supporting treatment of osteopenia and osteoporosis in patients with anorexia nervosa (AN). We identified controlled clinical studies of interventions for low bone mass in AN via searches of MEDLINE; the Cochrane Library; EMBASE; PsycINFO; and cumulative index to nursing and allied health literature.
ABSTRACT: Weight restoration is crucial for successful treatment of anorexia nervosa. Without it, patients may face serious or even fatal medical complications of severe starvation. However, the process of nutritional rehabilitation can also be risky to the patient. The refeeding syndrome, a problem of electrolyte and fluid shifts, can cause permanent disability or even death.
Anorexia nervosa is a difficult disease to treat effectively. Inpatient treatment in facilities with specialized expertise heightens the chance for success. Patients with the most severe degrees of anorexia nervosa are especially in need of hospitalization.
ABSTRACT: Of the many body systems adversely affected by severe anorexia nervosa (AN), the pulmonary system is relatively spared. However, in the face of severe malnutrition of AN, the lung may undergo architectural changes that adversely affect its integrity and healing capacity.
ABSTRACT: Anemia, leukopenia and thrombocytopenia are frequent complications of anorexia nervosa. The complete blood count provides useful information to diagnose and characterize these findings. Anemia tends to be normocytic and normochromic. Leukopenia manifests as a deficiency of lymphocytes or neutrophils. Thrombocytopenia, if severe, may confer a bleeding risk.
ABSTRACT: Two females with severe anorexia nervosa (BMI of 10) were seen with marked abnormalities in their liver function tests before the initiation of refeeding. These paradoxically resolved with progressive refeeding and weight restoration. Clinical observation during regimented medical stabilization and refeeding of two patients with severe anorexia nervosa with frequent monitoring of liver…
Mehler PS, Crowe S. Medical Complications of Anorexia Nervosa in Mitchell J. Gillo M. Eating Disorders Hand Book. 59-71, 2010.
Complement Activation in Severe Anorexia Nervosa: A Prospective Cohort Study.
Flierl MA, Gaudiani JL, Sabel A, Long CS, Stahel PF, Mehler PS. 'Complement Activation in Severe Anorexia Nervosa: A Prospective Cohort Study.' Eating Disorders Research Society, 2010.
ABSTRACT: Successful treatment of persons with anorexia nervosa is possible when a multidisciplinary team consisting of a mental health professional, a dietician, and a medical professional with expertise in eating disorders direct treatment. One of the primary goals of treatment is the restoration of weight.
ABSTRACT: To describe the phenomenon of persistent vaginal bleeding intwo patients with severe anorexia nervosa. We report two cases of young women with severe anorexia nervosa reporting vaginal bleeding that persisted for months despite trials of topical and systemic conjugated estrogen therapy.
ABSTRACT: We report data from the medical stabilization and refeeding of patients with severe anorexia nervosa admitted over a 15‐month period.
ABSTRACT: To present a cogent and practical review of the medical complications and their treatment in patients with bulimia nervosa. Thorough review of the medical literature from 1990 to current in regards to the medical complications of bulimia nervosa and the therapeutic intervention that are effective to treat them. Extensive and detailed review of the medical complications of bulimia…
ABSTRACT: Hyponatremia is infrequently reported in the constellation of metabolic abnormalities in patients with eating disorders. We sought to identify the etiology and describe the management of a patient with anorexia nervosa and hyponatremia. We report the case of a 23-year-old woman with anorexia nervosa who suffered with severe hyponatremia.
ABSTRACT: Osteoporosis is common in anorexia nervosa. It places these patients at increased lifetime risk for fractures. Bone loss may never recover completely even once weight is restored. The strongest predictors of osteoporosis include low body weight and amenorrhea. Loss of bone density can occur rapidly and very early in the course of anorexia nervosa. The etiology of bone loss in the…
ABSTRACT: Anorexia nervosa (AN) carries the highest mortality of any psychiatric disorder largely attributable to sudden cardiac death and suicide. Controversy exists regarding the underlying mechanism of cardiac risk, whether QT prolongation is a consistent feature of the disorder and whether repolarization varies by disease severity.
ABSTRACT: Anorexia nervosa carries the highest mortality rate of any psychiatric disorder. Even the most critically ill anorexic patients may present with normal 'standard' laboratory values, underscoring the need for a new sensitive biomarker. The complement cascade, a major component of innate immunity, represents a driving force in the pathophysiology of multiple inflammatory disorders.
ABSTRACT: Hypophosphatemia of refeeding is one of the most dangerous complications seen during the treatment of patients with anorexia nervosa. Although easily detectable and treatable, hypophosphatemia is under‐recognized as a complication of refeeding.
ABSTRACT: Grinspoon and colleagues (1) reported on predictive factors for osteopenia in anorexia nervosa. The accompanying editorial discussed potential pathophysiologic explanations that link body weight and bone mass (2).
ABSTRACT: PseudoBartter's syndrome, a complex pattern of seemingly unrelated metabolic abnormalities, is frequently seen in patients with eating disorders, particularly those who indulge in purging behaviors. We present two cases that, despite divergent background histories and clinical presentations, possess the unifying pathophysiology that ultimately leads to this syndrome.
ABSTRACT: The purpose of this case report is to increase awareness among clinicians that oropharyngeal dysphagia occurs in patients with severe anorexia nervosa, placing them at risk for aspiration and impeding nutritional rehabilitation.
ABSTRACT: The purpose of this case report is to increase awareness among clinicians that oropharyngeal dysphagia occurs in patients with severe anorexia nervosa, placing them at risk for aspiration and impeding nutritional rehabilitation. We describe a patient with severe anorexia nervosa who manifested symptoms of dysphagia, with resultant aspiration pneumonia, at the time of her admission for…
Herein we review the major medical issues involved in the “detoxing” of patients who engage in purging behaviors and the pathophysiology of why they occur. Given a limited evidence base of randomized controlled trials, we conducted a thorough qualitative review to identify salient literature with regard to the medical issues involved in “detoxing” patients from their purging behaviors.
ABSTRACT: Bulimia nervosa has many medical complications associated with the different modes of purging utilized by these patients. There also are inherent medical complications associated with chronic purging when these behaviors are abruptly discontinued.
Anorexia nervosa is characterized in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) by (1) a refusal to maintain a minimally normal body weight (eg, a body weight of <85% of expected body weight or a body mass index [BMI; calculated as weight in kilograms divided by height in meters squared] of <17.5), (2) an intense fear o
ABSTRACT: In this article, we will examine the most common emergency department presentations of eating disorder patients, review the pathophysiologic changes that lead to such presentations, and discuss the appropriate management of each patient. Literature review of current practices.
ABSTRACT: The purpose of this article is to clarify the finding of liver function test abnormalities in anorexia nervosa (AN). Literature review and description of two representative cases of severe liver function test abnormalities from our medical stabilization unit. Abnormal elevation of liver function tests can occur during the process of refeeding patients with severe AN.
ABSTRACT: Among psychiatric conditions, anorexia nervosa carries the highest mortality, in part due to the propensity for rhythm disturbances among patients with advanced disease. Patients with anorexia nervosa are prone to both bradycardia and tachyarrhythmias, though mortality has not been associated with the former.
ABSTRACT: Bulimia nervosa, often characterized by self-induced vomiting, is complicated by medical manifestations that affect nearly every organ system in the body. Effects range from superficial skin and dental findings to esophageal pathology, electrolyte abnormalities, cardiac arrhythmias, and in extreme cases, death.
ABSTRACT: Eating disorders are one of the “great masqueraders” of the twenty-first century. Seemingly healthy young men and women with underlying eating disorders present to emergency departments with a myriad of complaints that are not unique to patients with eating disorders.
Abstract
OBJECTIVE:
Osteoporosis has traditionally been considered a female problem. This study's purpose is to evaluate bone mineral density (BMD) in males with eating disorders.
'Hypokalemia: A marker of covert bulimia nervosa.' Philip S Muhler, MD. American Journal of Medicine.' 128(9):e37, 2015. DOI: 10.1016/j.amjmed.2015.02.024
ABSTRACT: The clinical presentation and medical complications of severe anorexia nervosa among males were examined to further the understanding of this increasingly prevalent condition. Fourteen males were admitted to a medical stabilization unit over the study period.
ABSTRACT: Prealbumin levels have been proven to correlate with hospital length of stay, wound healing, infection rates, and mortality in adults hospitalized for medical or surgical purposes, or those who have chronic illnesses. Little is known about the utility of prealbumin evaluation in adults with severe anorexia nervosa (AN).
ABSTRACT: Bulimia nervosa is a psychiatric disorder with many different medical sequelae. This article reviews the principal medical complications associated with bulimia nervosa, and emphasizes the importance of a timely approach to diagnosis and management.
Abstract
Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images.
ABSTRACT: In contrast to other mental health disorders, eating disorders have a high prevalence of concomitant medical complications. Specifically, patients suffering from anorexia nervosa (AN) have a litany of medical complications which are commonly present as part of their eating disorders.
Nutritional rehabilitation and weight restoration are key underpinnings of the treatment protocol for patients with anorexia nervosa. While their inherent state of malnutrition and weight loss is certainly not a healthy one, ironically, the very essence of the refeeding process, if done injudiciously, can also be unsafe for patients with anorexia nervosa.
ABSTRACT: This study assessed the personality of severely ill patients with anorexia nervosa, restricting (AN-R) and binge-purge subtypes (AN-BP), during hospitalization for medical stabilization. Participants (N = 37) completed the Temperament and Character Inventory, Revised. Personality domains were similar between AN-R and AN-BP with the exception of cooperativeness.
ABSTRACT: Anorexia nervosa has the highest mortality of any psychiatric illness. Yet, these patients are often young and have many productive years yet to live. Weight restoration and nutritional rehabilitation, along with psychotherapy, are at the core of a successful treatment plan along with avoiding medical complications during the early periods of refeeding.
As with anorexia nervosa, there are many medical complications associated with bulimia nervosa. In bulimia nervosa, these complications are a direct result of both the mode and the frequency of purging behaviors.
ABSTRACT: As with anorexia nervosa, there are many medical complications associated with bulimia nervosa. In bulimia nervosa, these complications are a direct result of both the mode and the frequency of purging behaviors.
ABSTRACT: Inherent to anorexia nervosa and bulimia nervosa are a plethora of medical complications which correlate with the severity of weight loss or the frequency and mode of purging. Yet, the encouraging fact is that most of these medical complications are treatable and reversible with definitive care and cessation of the eating-disordered behaviors.
ABSTRACT: Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of anorexia nervosa, as well as from the purging behaviors that characterize bulimia nervosa.
ABSTRACT: The purpose of this article is to thoroughly review the medical complications associated with bulimia nervosa and their evidenced-based or typical treatments. A thorough review of medical literature to cull pertinent and best articles which guide the diagnosis and treatment of the medical complications of bulimia nervosa was performed.
ABSTRACT: Forty‐seven year old female, with a history of anorexia nervosa, was admitted to a medical stabilization unit (ACUTE) complaining of abdominal pain exacerbated by oral intake, associated with nausea, and relieved by emesis.
Thanksgiving is a time for families and friends to gather, express gratitude and enjoy a meal together. Unfortunately, this time of year is also associated with an increased risk of food poisoning. This Thanksgiving, the American Association of Poison Control Centers (AAPCC) and the Rocky Mountain Poison & Drug Safety (RMPDS) encourage everyone to take a few simple food safety precautions to…
Denver Health has been named a 2014 Top Performer on Key Quality Measures by the Joint Commission, the leading accreditor of health care organizations in the United States.
ABSTRACT: Anorexia nervosa is an eating disorder, which is associated with many different medical complications as a result of the weight loss and malnutrition that characterize this illness. It has the highest mortality rate of any psychiatric disorder.
The American Cancer Society recognized Elizabeth Bibiloni with the Lane W. Adams Quality of Life Award, a prestigious national honor for cancer care and commitment.
Dr. Madeleine Kane, Chief of Hematology and Oncology, Elected Chair of the Colorado Cancer Coalition
Denver Health’s Madeleine Kane, MD, PhD, was elected Chair of the Colorado Cancer Coalition (CCC) by her colleagues in January.
ABSTRACT: Evaluation of liver dysfunction in patients with severe anorexia nervosa (AN) has typically been limited to small case series. We report an investigation into the admission characteristics and clinical outcomes associated with liver dysfunction in a large cohort of adults hospitalized for medical stabilization of severe AN.
ABSTRACT: Oropharyngeal dysphagia (OPD) refers to difficulty swallowing food or a liquid bolus from the oral and pharyngeal cavities into the esophagus and increases the risk of possibly life‐threatening pneumonia. Little has been reported on OPD in adults with anorexia nervosa (AN).
Colorado’s Chapter of the American College of Emergency Physicians (ACEP) recognized Christopher Colwell, MD, with the Meritorious Service Award for his long history of service to the ACEP.
Tracy Johnson, PhD, Director of Health Reform Initiatives at Denver Health, was recently awarded a Health Policy Fellowship from the Commonwealth Fund.
The Fellowship, one of only two awarded this year, offers outstanding U.S. health policy researchers and practitioners a unique opportunity to spend up to 10 months in Australia conducting original research and working with leading Australian…
The Society of University Surgeons Honors Dr. Ernest E. "Gene" Moore with Lifetime Achievement Award
The Society of University Surgeons (SUS) honored Denver Health’s Ernest E. “Gene” Moore, MD, with the 2015 SUS Lifetime Achievement Award.
ABSTRACT: Anorexia nervosa portends the highest mortality among psychiatric diseases, despite primarily being a disease of adolescents and younger adults. Although some of this mortality risk is attributable to suicide, many deaths are likely cardiovascular in etiology. Recent studies suggest that adverse myocardial structural changes occur in this condition, which could underlie the increased…
ABSTRACT: Eating disorders that are associated with purging behaviors are complicated by frequent blood electrolyte and acid‐
ABSTRACT: Medical problems that arise due to severe restricting and/or purging may be misdiagnosed or sub-optimally treated, from outpatient clinics to top medical hospitals. A symptom may be presumed to be a psychological manifestation of the eating disorder and inappropriately dismissed for further medical evaluation.
The Denver School-Based Health Center (SBHC) Program—sponsored by Denver Health—was recently awarded $1.26 million to support comprehensive and integrated health services for the 2016-2017 school year from the Colorado Department of Public Health and Environment (CDPHE).
'Don’t forget the “medical” in eating disorder patients'. International Journal of Eating Disorders.
Denver Health Medical Center and the University of Colorado School of Medicine announced today that Mitchell Jay Cohen, MD, will join the hospital as the Director of Surgery and the School of Medicine as a professor in the Department of Surgery.
ABSTRACT: Anorexia nervosa is a serious mental illness with a high mortality rate. The body image distortion inherent to this disorder and the impaired judgment and cognition due to malnutrition frequently result in patients refusing treatment. Treatment is most effective if patients are treated early in the course of their illness and undergo a full course of treatment.
After an extensive national search, Denver Health is pleased to announce that Dr. Edward P. Havranek has been selected as our new Director of Medicine, effective immediately.
Dr. Kathy Wells, a pediatrician at Denver Health and the medical director for the Family Crisis Center, was named to Governor Hickenlooper’s Task Force on the Collection and Security of Digital Images of Child Abuse or Neglect earlier this month.
Denver Health and Kaiser Permanente have launched Colorado Patient Partners in Research (CoPPiR) - a unique program that connects patients with ongoing research studies. This first of its kind program allows patients to become contributing members of research teams on a variety of health topics.
Denver Health’s school based health clinics (SBHC) offer a helping hand to Denver Public School (DPS) students and their families with no cost, convenient health care.
Dr. Debbie Rinehart, an associate research scientist at Denver Health’s Center for Health Systems research, has been awarded a PCORI Pipeline Award to create a patient advisory committee to ensure patient perspectives and needs are built into future research projects.
Abstract
Patients with anorexia nervosa often voice a multitude of symptoms in regards to their gastrointestinal tract.
This study examines adult patients with severe, life-threatening anorexia nervosa who were admitted to an inpatient, medical stabilization unit between October 1, 2008 and December 31, 2014. Specifically, the study compares anorexia nervosa, binge purge subtype (AN-BP) and anorexia nervosa, restricting subtype (AN-R) on admission measures, hospital course, and outcomes.
Twenty years ago, what was then known as Denver General had a milestone in its history. In 1997 the City of Denver established the Denver Health and Hospital Authority as an independent entity from its longstanding city governorship. The decision, supported by the State of Colorado, gave Denver Health ownership over its own future, and the financial decision-making that would help hospital…
There has been a recent policy change to MyChart at Denver Health. The minimum patient age for an active account is now 12.
DENVER, CO (January 27, 2017) – Denver Health and Hospital Authority (DHHA) is pleased to announce Robin Wittenstein, Ed.D., FACHE, as the finalist for the Chief Executive Officer position following a vote last night by the DHHA Board of Directors.
Denver Health has named Romana Hasnain-Wynia, PhD, to the newly created role of Chief Research Officer.
Denver Health is proud to celebrate inclusiveness and diversity among our staff. No matter what your native tongue is, we speak your language. Denver Health pr
ABSTRACT: Anorexia nervosa (AN) is a complex mental health disorder that may result in life threatening medical complications if not properly treated. Refeeding and weight restoration are the primary goals of treatment in AN.
Denver Health’s longstanding commitment to process improvement helped it earn recognition for the second time in five years from Rocky Mountain Performance Excellence with another Peak Award, coming at the end of 2016.
When avoidant/restrictive food intake disorder becomes life-threatening: A case report of an adult male patient. Colorado Journal of Psychiatry & Psychology 2017; 2(2): 23-28. To read the full abstract of this article, visit the link below.
Denver Health was named a 2017 Distinguished Hospital Award for Clinical Excellence by Healthgrades -- placing it among the top five percent of hospitals in the U.S.
The Human Rights Campaign (HRC) Foundation has recognized Denver Health for the fourth year in a row as a "Leader in LGBTQ Health Care Equality." The HRC is the educational arm of the country’s largest lesbian, gay, bisexual and transgender (LGBT) civil rights organization.
One year ago today, Denver Health’s Federico F Peña Southwest Family Health Center opened its doors to the community in one of the most underrepresented neighborhoods in Denver. This state-of-the-art facility brought many new possibilities to a population previously without a neighborhood option for health care.
Songs for Sound (SfS), a Nashville-based nonprofit, will be parked outside Denver Health’s Bernard F. Gipson Eastside Family Health Center, from 10 a.m. to 3 p.m. on Tuesday, May 2, to offer free hearing tests.
Have you ever seen the news about a health outbreak and wondered what would happen in Colorado?
This June, Denver Public Health, Denver Environmental Health and other local response partners, are participating in a full-scale, statewide Public Health Emergency Dispensing Exercise (PHED Ex 2017) to practice quickly giving away emergency medications to people during a health crisis.
Join your Denver Health colleagues at this year’s Denver PrideFest, the largest regional celebration of LGBT pride in Colorado, June 17 and 18 at Civic Center Park. While you’re there, don’t forget to visit the Denver Public Health booth!
Hospitals Use Technology to Partner with Patients on Health
\For the 12th year in a row, Denver Health has been recognized as a “Most Wired” health care system by the American Hospital Association’s (AHA) Health Forum.
ABSTRACT: This study evaluates potential associations of baseline physical function measures with anthropometrics and clinical outcomes in persons hospitalized with anorexia nervosa. We conducted a retrospective study in a single hospital on 176 seriously ill persons with anorexia nervosa who required definitive medical stabilization.
Join the Denver Health and Denver Public Health team Saturday, Aug.19, at Cheesman Park, for the 30th annual AIDS Walk Colorado. The walk celebrates huge leaps in HIV treatment, to honor those we have lost, and demonstrate our commitment to ending the HIV/AIDS epidemic by 2030.
August 12 and 13, the Denver Health Paramedic Division deployed fireline paramedic Will Berry to the Pole Creek Fire in Kemmerer, Wyo., and radio operator Adam Ellis to the Gibralter Fire in Eureka, Mont.
Denver Health was founded as City Hospital in 1860 to serve the health care needs of the rapidly developing city of Denver. Since then, we have grown alongside the community to become a complete health care system, proudly providing care for all residents.
Twenty years ago, what was then known as Denver General had a milestone in its history. In 1997 the City of Denver established the Denver Health and Hospital Authority as an independent entity from its longstanding city governorship. The decision, supported by the State of Colorado, gave Denver Health ownership over its own future, and the financial decision-making that would help hospital…
ABSTRACT: Anorexia nervosa (AN) has the highest mortality rate of all psychiatric illnesses due to the widespread organ dysfunction caused by the underlying severe malnutrition. Starvation causes hepatocyte injury and death leading to a rise in aminotransferases.
ABSTRACT: Young adults with eating disorders can develop osteoporosis, or fragile bones, which can cause lifelong debilitating consequences. Despite its high prevalence, general guidelines for diagnosis and treatment are lacking and further collaboration is needed. Some current osteoporosis medications may have severe side effects or cause birth defects in pregnant women and thus require special…
Read the most recent 'Admissions' blog article from the Hospital Medicine team, "What Guppies Taught Me About Doctoring".
Most patients don’t know who Dr. Bernard F. Gipson Sr. is, but his legacy lives on at Denver Health for his work bringing care to all during the early days of the Eastside Family Health Center. The Center is named for Dr. Gipson, who was Denver’s first black surgeon and treated Dr. Martin Luther King for altitude sickness during a trip here in the height of the civil rights era. Learn more about…
