Guidelines for Inpatient Medical Stabilization · 2018-01-11 · Admission to an acute care...
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The following recommendaons are aimed at idenfying paents at high risk for refeeding syndrome and other dangerous medical condions. In refeeding syndrome, potenally fatal shiſts of fluids and electrolytes occur while refeeding a malnourished paent. Admission to an acute care hospital with eang disorders experse allows the paent to begin recovery in the safest and most successful way possible, using the medical insurance benefit. It is strongly recommended that paents with ANY ONE of the following begin treatment in a medical hospital, rather than a residenal treatment center (RTC) or lower level of care: For paents with ANY TWO of the following, hospitalizaon is likely to be the most appropriate choice. Admission to RTC or lower level of care should be approved by a medical provider: Guidelines for Inpatient Medical Stabilization BMI < 17 (adults) Weight loss > 15% in the past 3 months Calorie intake < 200 kcal/day for past 5-10 days Heart rate < 50 beats per minute on ECG or by pulse Temperature < 97.0 Systolic blood pressure < 90 mmHg • • • • • • • • • • • • • • • • • • Adults: Body Mass Index (BMI) <15 Adolescents: BMI <3rd percenle with any weight loss OR <75% of expected or previous BMI. If expected BMI is unknown, use 50th percenle for age* Weight loss >20% over the past 3 months (any previous weight) Lile or no calorie intake (<200 kcal/day) for 10 days or more Low phosphorus, magnesium, or sodium Potassium <3.0 Glucose <60 Unable to consume at least 1300 kcal/day by mouth Dehydraon ECG abnormalies: QTc >450, HR <44, other arrhythmias Eang disorder diagnosis is uncertain (concern that paent may have a medical condion or disease) Gastrointesnal condions interfering with eang Adolescents: Use CDC BMI-for-age charts Boys: www.cdc.gov/growthcharts/data/set2clinical/cj41l073.pdf Girls: www.cdc.gov/growthcharts/data/set2clinical/cj41l074.pdf *
Transcript of Guidelines for Inpatient Medical Stabilization · 2018-01-11 · Admission to an acute care...
The following recommendations are aimed at identifying patients at high risk for refeeding syndrome and other dangerous medical conditions. In refeeding syndrome, potentially fatal shifts of fluids and electrolytes occur while refeeding a malnourished patient.
Admission to an acute care hospital with eating disorders expertise allows the patient to begin recovery in the safest and most successful way possible, using the medical insurance benefit.
It is strongly recommended that patients with ANY ONE of the following begin treatment in a medical hospital, rather than a residential treatment center (RTC) or lower level of care:
For patients with ANY TWO of the following, hospitalization is likely to be the most appropriate choice. Admission to RTC or lower level of care should be approved by a medical provider:
Guidelines for Inpatient Medical Stabilization
BMI < 17 (adults)
Weight loss > 15% in the past 3 months
Calorie intake < 200 kcal/day for past 5-10 days
Heart rate < 50 beats per minute on ECG or by pulse
Temperature < 97.0
Systolic blood pressure < 90 mmHg
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Adults: Body Mass Index (BMI) <15
Adolescents: BMI <3rd percentile with any weight loss OR <75% of expected or previous BMI.
If expected BMI is unknown, use 50th percentile for age*
Weight loss >20% over the past 3 months (any previous weight)
Little or no calorie intake (<200 kcal/day) for 10 days or more
Low phosphorus, magnesium, or sodium
Potassium <3.0
Glucose <60
Unable to consume at least 1300 kcal/day by mouth
Dehydration
ECG abnormalities: QTc >450, HR <44, other arrhythmias
Eating disorder diagnosis is uncertain (concern that patient may have a medical condition or disease)
Gastrointestinal conditions interfering with eating
Adolescents: Use CDC BMI-for-age chartsBoys: www.cdc.gov/growthcharts/data/set2clinical/cj41l073.pdfGirls: www.cdc.gov/growthcharts/data/set2clinical/cj41l074.pdf
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Orthostatic changes (> 40 beats increase in heart rate or > 15 mmHg drop in systolic blood pressure)
Active alcohol or drug abuse within the week prior to admission
Anorexia nervosa with purging
Long term use of insulin, chemotherapy, diuretics, H2-blockers, proton pump inhibitors, laxatives, immunosuppressants,
or prednisone
Chronic disease, such as Crohn’s disease, ulcerative colitis, HIV, diabetes mellitus
Any electrolyte abnormality
Please note that these guidelines may not identify all patients that should be admitted to a hospital for medical stabilization. In case of any uncertainty, refer to a physician with eating disorders experience.
*Patients use only the medical insurance benefit, preserving their behavioral health coverage for residential, PHP, and/or IOP treatment.
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Guidelines for Inpatient Medical Stabilization Cont.
We Provide:
Outpatient (office visit) medical assessment and consultation.
Inpatient medical stabilization for males and females ages 13 to 35*
Continuing medical care (office visits) for patients who have successfully completed
treatment in a residential, partial hospital program (PHP), or intensive outpatient program (IOP) setting.
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Call 310-325-4353 | 24-hour AvailabilityLearn more about us at: TorranceMemorial.org/EatingDisorders
References:Mehanna HM, Moledina J, and Travis J: Refeeding syndrome: what it is, and how to prevent and treat it BMJ 2008 Jun 28; 336(7659): 1495 - 1498Eatng Disorders; A Guide to Medical Care AED Report 2016 3rd ed.
