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Medical Parameters for Health. Or “What does the doctor do, anyway, and why does she do it that way?”. Laura Koenigs, MD Director, Adolescent Medicine Baystate Children’s Hospital Springfield, MA. Objectives. Describe differential diagnoses of weight loss and vomiting

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medical parameters for health

Medical Parametersfor Health

Or “What does the doctor do, anyway, and why does she do it that way?”

Laura Koenigs, MD

Director, Adolescent Medicine

Baystate Children’s Hospital

Springfield, MA

objectives
Objectives
  • Describe differential diagnoses of weight loss and vomiting
  • Describe techniques for determining ideal body weight
  • Describe common medical complications of eating disorders
tasks for provider
Tasks for Provider
  • Establish diagnosis
  • Set parameters for normal weight
  • Set guidelines for activity
  • Clarify need for hospitalization
  • Organize a team
irreversible medical consequences
Irreversible Medical Consequences
  • Growth retardation
  • Structural brain changes
  • Decreased peak bone mass
  • Loss of dental enamel
establish diagnosis1
Establish Diagnosis
  • History
  • Physical
  • Laboratory tests
  • ECG
differential diagnosis
Differential Diagnosis
  • Endocrine diseases
differential diagnosis1
Differential Diagnosis
  • Endocrine diseases
  • Gastrointestinal diseases
  • Neurologic diseases
  • Malignancies
  • Connective tissue diseases
  • Chronic infection
  • Other psychiatric illnesses
symptoms of starvation
Symptoms of Starvation
  • Cold all the time
  • Tired
  • Full easily
  • Constipated
  • Sad/ Irritable
  • Hair changes
signs of starvation
Signs of Starvation
  • Bradycardia
  • Hypotension
  • Hypothermia
  • Lanugo / Balding
  • Yellow discoloration – hands
  • Acrocyanosis
  • Ketosis
signs of vomiting
Signs of Vomiting
  • Orthostasis
  • Parotid Swelling
  • Subconjunctival hemorrhages
  • Facial petechiae
  • Tooth enamel erosion
  • Russell’s sign
  • Extremity edema
medically stable
Medically Stable?
  • Severe malnutrition (≤ 75% av.)
  • Heart rate (<45)
  • Temperature (<96)
  • Heart dysrthymia
  • Hypoglycemia
  • Electrolyte or divalent abnormalities
  • Orthostasis/ Hypotension
criteria for admission
Criteria for Admission
  • Medical instability
  • Medical complications of malnutrition
  • Arrested growth/development
  • Uncontrolled binging / purging
  • Acute psychiatric emergencies
  • Failure of outpatient treatment

Society Adol Med Position Paper J Adol Health 2003; 33:496-503

what should a person weigh
What Should a Person Weigh?
  • Preadolescent: 11-14% body fat
  • Adult woman’s body: 20-25% fat
  • Adult male’s body 8- 11% fat
determining weight
Determining Weight
  • Adult woman (≥18 y/o)

100 lbs for first 5 feet

5 lbs per inch over 5 feet

Give/take 5-10%

  • Works best at normal heights
bmi charts
BMI Charts
  • CDC
  • Weight divided by height squared
  • Change with age
    • Adults NL: 18.5-24.9 kg/M2
  • Elite athletes, strength sports - 50th% BMI
sample child
Sample Child
  • 12 year old girl
  • 4’10” tall 62 pounds
  • BMI of 13 kg/M2
sample child1
Sample Child
  • 12 year old girl
  • 4’10” tall, 62 pounds
  • BMI of 13 kg/M2
  • Ideal BMI 16.5-20.2 kg/M2
  • 79- 96 lbs., 87 lbs. 50th %
sample child2
Sample Child
  • 12 year old girl
  • 4’10” tall, 62 pounds
  • BMI of 13 kg/M2
  • Ideal BMI 15.4-18.0 kg/M2
  • 71-87 lbs., 87 lbs. 50th %
following patient
Following Patient
  • Make diagnosis
  • Established normal weight range
  • Gather team
  • Criteria for admission
following patient1
Following Patient
  • Orthostatic vital signs
  • Same scale
  • Wearing only hospital gown
  • Post void
  • Check urine for specific gravity
  • Check oral temperature after bathroom
weight restoration goals
Weight Restoration Goals
  • Outpatient
    • ½ to 1 lb per week
  • Inpatient
    • 2-3 lb per week
caloric needs
Caloric Needs
  • Basal Metabolic Rate
    • Going 24/7
    • Higher if more muscle
  • Normal activity
    • Include growth
  • Exercise
basal metabolic rate
Basal Metabolic Rate
  • Child
    • Higher than adult to include growth
  • Adult
    • 10 X weight in pounds
slide35
BMR
  • Goes down with starvation
  • Goes down with Binge/Purge
  • Goes up with temperature extremes
  • Goes up with frequent feedings
calorie needs
Calorie Needs
  • 25% of a person’s calories should be from fat.
  • 50 - 60 grams of fat per day = low fat diet.
dietary guidelines
Dietary Guidelines

Not gaining weight?

  • Not eating enough or
  • Too much exercise
anorexia nervosa amenorrhea
Anorexia Nervosa & Amenorrhea
  • 25% Precedes weight loss
  • 50% Occurs with weight loss
  • 25% Follows weight loss
  • BMI < 19 kg/M²
  • Exercise prior to menarche
  • Low fat diet.
birth control pills
Birth Control Pills
  • Osteopenia/Osteoporosis = complication of eating disorder
  • Birth Control pills have not been shown to help
  • False sense of security
review
Review
  • Diagnosis – r/o medical causes as well as fulfilling DSM-IV
  • Physician should give parameters
    • Medical stability
    • Weight goals
    • Activity guidelines
    • Hospitalization guidelines