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Anorexia nervosa with medical instability — MCCQE Part 1 MCQ

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HardWeight LossAnorexia nervosa with medical instabilityMCCQE Part 1

A 16-year-old with restrictive eating has lost 12% of body weight in 2 months. Supine heart rate is 44/min, blood pressure is 86/54 mm Hg, potassium is 3.1 mmol/L, and the patient reports presyncope on standing. What is the most appropriate disposition?

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Correct answer: C — Urgent hospital assessment for medical stabilization

This adolescent has multiple markers of medical instability: marked daytime bradycardia, systolic hypotension, hypokalemia, rapid weight loss, and orthostatic symptoms. Canadian Paediatric Society guidance supports urgent hospital assessment and stabilization when these features are present. Admission decisions must not rely on body mass index alone; serious instability can occur at any weight after rapid restriction. Hospital care permits cardiac monitoring, controlled refeeding, repeated electrolyte assessment, and management of refeeding risk while the multidisciplinary eating-disorder plan is organized. A single potassium dose or delayed outpatient review does not address the immediate arrhythmia and hemodynamic risks. Exercise is unsafe during acute medical instability.

Reference: Canadian Paediatric Society, A guide to the community management of paediatric eating disorders, https://cps.ca/en/documents/position/eating-disorders