Anorexia nervosa requiring admission in adolescents

Abstract

Question I recently saw in my office a patient whom I had initially diagnosed with anorexia nervosa 6 months earlier and she was continuing to lose weight. Her physical examination findings in the office revealed a blood pressure of 85/55 mm Hg and a heart rate of 55 beats/min at rest. Should patients such as this one be sent to the hospital for inpatient monitoring and treatment?

Answer There is a lack of clear evidence-based guidelines for hospital admission of adolescents with anorexia nervosa, resulting in a high degree of variation in practices among physicians. Clinical judgment based on expert opinion seems to be the main driver of the decision to admit for inpatient care. Acceptable indications for a patient’s admission include the following: weight is less than 75% of ideal body weight, temperature is lower than 35.5°C (95.9°F), heart rate is less than 45 beats/min, systolic blood pressure level is lower than 80 mm Hg, orthostatic change in pulse is higher than 20 beats/min, or orthostatic change in blood pressure is greater than 10 mm Hg. Consultation with an adolescent medicine specialist is highly recommended for adolescents with these vital signs.