Thursday, March 22, 2012: 8:30 AM-10:30 AM
Yellow Topaz (The Charleston Marriott)
Patients who engage in severe restricting and/or purging behaviors can experience medical complications that encompass every organ system. These complications are worrisome to the patients and their primary care providers, psychiatrists, therapists, dieticians, nurses, social workers, and family members. In a case-based format, we will review recognition, diagnosis, and management.
I. Cases of complications related to restriction
A. Vital sign abnormalities (hypothermia, bradycardia, hypotension)
B. Refeeding syndrome
C. Hypoglycemia
D. Hepatitis
E. Gastroparesis, SMA syndrome
F. Dysmenorrhea
G. The abnormal CBC
H. Rare manifestations of severe underweight: dysphagia, dysphonia, and lagophthalmos
II. Cases of complications related to restriction and purging
A. The severely abnormal chemistry panel: hyponatremia, hypokalemia, hypercarbia, featuring volume depletion
B. Constipation and detoxing off of laxatives
C. Edema and detoxing off of diuretics
D. Sialadenosis and detoxing off of vomiting
In this three hour workshop, we will present a case-based, interactive, and evidence-based review of the most common and dangerous medical complications associated with severe restriction and severe purging behaviors. These complications are worrisome to the patients and their primary care providers, psychiatrists, therapists, dieticians, nurses, social workers, and family members. All too often, medical care of patients with severe eating disorders is suboptimal due to clinicians' lack of formal training, lack of experience with this patient population, and historic lack of a robust evidence base which can guide best practices. The ACUTE Center for Eating Disorders at Denver Health provides multi-disciplinary expertise in the medical stabilization of patients with eating disorders, when their medical condition has become too severe even for admission to a traditional residential eating disorder program. Through our clinical experience with these patients, with a median admission BMI of 12-13 kg/m2, and our publications on the many medical problems they experience both during the starved and during the early refeeding state, we can present cases and therapeutic options for managing these common and dangerous problems. All too often, patients’ negative experience with the medical community contributes to their lack of trust in their providers, as they frequently are more knowledgeable about their physiology than the physician treating them. Indeed, a majority of patients with severe eating disorders relate stories of under-management, mis-management, and iatrogenic complications of care in medical hospitals which have delayed their stabilization, distracted from their community providers’ goal of care (since severe medical problems and repeated trips to the emergency department become the focus, rather than advancing the therapeutic and nutritional plan), and prevented a more timely recovery. We will review cases of patients with severe restriction alone, and cases of patients with severe purging behaviors, in order to help providers of all types to successfully recognize, diagnose, and manage these medical complications. In addition, all who care for patients with eating disorders should be able to identify when their patient needs a higher level of care.
Primary Presenter:
Philip S. Mehler, MD
Philip S. Mehler, MD, CEDS, FAED earned his medical degree from the University of Colorado School of Medicine, and has been a physician at Denver Health for more than 20 years. He has dedicated most of his career to the research and care of patients suffering from severe eating disorders. In addition to his normal duties as Chief Medical Officer at Denver Health, Dr. Mehler is the Medical Director of the ACUTE Center at Denver Health. He has authored more than 175 publications including many on the treatment and effects of severe eating disorders.
Co-Presenter:
Jennifer L. Gaudiani, MD
Jennifer L. Gaudiani, M.D. completed her undergraduate work at Harvard College, earned her medical degree from Boston Univeristy School of Medicine in 2002, and completed her residency and chief residency in Internal Medicine at Yale. Dr. Gaudiani is board-certified in Internal Medicine, practices hospitalist medicine at Denver Health, has lectured broadly on the topic of eating disorders, and has published extensively on the medical complications of eating disorders. Dr. Gaudiani is the Assistant Medical Director of ACUTE at Denver Health.
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