When the body is out of resources- Anorexia and Critical Care
Dr Bethany Foster, Dr Raluca Ene, Dr Venkat Sundaram, Glan Clwyd Hospital, Wales, UK
A 44-year-old lady was admitted to our hospital following a fall. She had a previous medical history of smoking, intermittent alcohol excess and Anorexia Nervosa since the age of 14. On arrival to A&E she was found to be in cardiogenic shock, have profound metabolic derangements and be hypothermic. Gross pitting oedema and multiple pressure wounds were noted on her extremities.
She was admitted to Intensive Care for vasopressor support and metabolic derangement correction. She developed respiratory failure and was intubated and ventilated. Poor mobility was noticed in the left arm. A CT head revealed an acute infarct in the right mid parietal region and a subacute infarct in the left occipito-parietal region. It showed advanced atrophy for her age and multiple chronic subdural haematomas. After a month in ICU she was discharged to the ward and is making a slow recovery with ongoing nutritional issues.
The MARSIPAN guideline is a useful tool to manage critically ill patients suffering with anorexia nervosa. It highlights the concerns and management of refeeding and underfeeding and the importance of multidisciplinary involvement with psychiatry and nutritional teams.
Anorexia is a mental health issue with multisystem physiological consequences. Its incidence is increasing, and more patients are requiring hospitalisation for treatment. Management in a Specialised Eating Disorder Unit(SEDU) is preferable. Anorexic patients often benefit from HDU/ICU monitoring