A 20-year-old woman with anorexia nervosa has a BMI of 13.5 kg/m². Her awake heart rate is 38 beats/min and her QTc is 490 ms. Serum phosphate is 0.5

Question

A 20-year-old woman with anorexia nervosa has a BMI of 13.5 kg/m². Her awake heart rate is 38 beats/min and her QTc is 490 ms. Serum phosphate is 0.5 mmol/L and potassium is 2.8 mmol/L. There is no evidence of infection or another acute inflammatory illness. Which immediate management plan best accords with current UK Medical Emergencies in Eating Disorders (MEED) guidance?

Accepted Answer

Admit to acute medical or HDU-capable care; institute cardiac monitoring, give thiamine and replace electrolytes while starting refeeding at about 20 kcal/kg/day

Answer

Replace the electrolytes in ambulatory care; discharge when the QTc improves and arrange specialist outpatient refeeding within 48 hours

Answer

Admit to acute medical care; withhold nutrition until potassium and phosphate normalise, then start refeeding at 5 kcal/kg/day with ECG monitoring

Answer

Admit directly to specialist eating-disorder care; begin refeeding at 30–35 kcal/kg/day immediately, with routine daily ECG and blood monitoring

Answer

Admit to a general psychiatric ward; start refeeding at 10 kcal/kg/day and arrange medical transfer only if an arrhythmia or refeeding syndrome develops

Extreme Medical Risk in AN — MRCPsych Paper B MCQ