Anorexia – medical instability — RACP Paediatrics MCQ

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ModerateEmergencyAnorexia – medical instabilityRACP Paediatrics

A 15-year-old with anorexia nervosa presents with BMI 13.5, HR 42 bpm, BP 80/50 mmHg, temperature 35.2°C, and postural hypotension. ECG shows a prolonged QTc. What is the most appropriate immediate management?

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Correct answer: C — Immediate medical stabilisation

This adolescent has medical instability criteria for inpatient admission (severe bradycardia <50 bpm, hypotension, hypothermia, prolonged QTc) and requires immediate medical stabilisation. This takes priority over psychiatric assessment. Management includes telemetry monitoring, slow cautious refeeding (to prevent refeeding syndrome), phosphate/electrolyte monitoring, and thiamine supplementation.

Reference: RCH Melbourne – 2023 – Eating Disorders CPG; RACP Paediatric Curriculum – Adolescent Medicine