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Adolescent eating disorder — CCFP MCQ

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HardPaediatrics and adolescentAdolescent eating disorderCCFP

A 15-year-old girl has lost 12 kg in 4 months. Current measurements are: BMI 16.2 kg/m², heart rate 44 bpm, blood pressure 88/56 mmHg, temperature 35.7°C, and serum potassium 3.1 mmol/L. She denies purging but reports compulsive exercise and food restriction. What is the most appropriate next step in management?

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Correct answer: E — Arrange urgent hospital assessment for medical instability from an eating disorder

Explanation lettering: B = shown as A · C = shown as B · D = shown as C · E = shown as D · A = shown as E

This is a medically unstable adolescent requiring emergency assessment and admission. The patient meets established criteria for hospitalization: bradycardia (44 bpm, threshold ≤45), hypotension (88/56, near or below 80 mmHg threshold), near-critical hypothermia (35.7°C, critical <35.5°C), hypokalemia, and rapid weight loss over 4 months. Canadian eating disorder programs explicitly exclude medically unstable patients from outpatient care and triage them urgently. The absence of purging is irrelevant; restrictive eating disorders (including atypical anorexia nervosa) cause severe cardiopulmonary and electrolyte derangements independent of purging behaviour. Outpatient CBT (B), appetite stimulants (C), reassurance (D), and dietary counselling (E) are all contraindicated in acute medical instability. Hospitalization is necessary for cardiac monitoring, electrolyte repletion, careful refeeding, and stabilization before psychological treatment can proceed.

Reference: Canadian Family Physician. Anorexia nervosa requiring admission in adolescents. 2019. https://www.cfp.ca/content/cfp/65/2/107.full.pdf