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Effects of Disordered Eating on HealthOutlineThink organ systemsMetabolic changesRefeeding syndromeCompensatory strategiesStarvation or Semi-starvationLoss of lean massDecrease in metabolic rateLoss of bone mineral densityHigh risk for nutrient deficiencies: iron, zinc, vitamin E & DGlycogen depletionDehydration Cardiovascular ChangesFunctional & structural abnormalities even for illnesses of short durationAppear to be reversible w/ early ID and treatmentBradycardiaOrthostatic hypotension aka: postural orthostatic tachycardia syndrome (POTS)Systolic 70-90 mm Hg commonOrthostatic heart rateDecreased heart size, chamber size & wall thicknessResults in reduced cardiac outputLow voltageMitral valve prolapseCongestive heart failureElectrolytesHypokalemia = < 3.5 mmol/kgBradycardiaCardiac arrhythmiaCardiac arrestChronic hypokalemia -> renal failureHyponatremia = <135 mmol/kgCramping, spasms, dizziness, light-headed, seizures, comaLinear GrowthImpaired linear growthMore bone growth retardation if pre-menarchealComplete vs. incomplete catch-up growthD/t:Low thyroxine (T4)Low triiodothyronine (T3)High cortisolLow sex hormonesChanges in GH-IGF axis which impacts longitudinal bone growthMetabolic RateBMR typically 60-70% total E expenditureE restriction causes decreased BMRDecline BMR mainly due to loss in lean tissue and down regulation of non-essential systemsDecrease in TEFAlterations in thyroid activityEndocrine AbnormalitiesThyroid-pituitary axis responds to starvation by decreasing production of thyroid hormone (mimics hypothyroid Dz)Slowed metabolismFatigueCold intoleranceDry skinBradycardiaConstipationLethargyDepressionMDs must be careful not to mis-Dx hypothyroidism and prescribe thyroid hormoneFood & MoodDietary protein & fat trigger release of CCKProvides feeling of fullness/satietyDietary protein impacts dopamineNeurotransmitter causing feeling of alertnessFat influences production of endorphinsBody’s natural pain killerCHO, esp. simple sugars, stimulates serotoninNeurotransmitter inducing calmness & sleepinessReproductive DysfunctionVariety of dysfunctionsAmenorrhea Primary or secondaryLuteal phase elongationDue to progesterone deficiencyAnovulationAbnormal menstrual cyclesOligomenorrhea (> 35 d)Very short cycles (< 21 d)Also due to progesterone deficiencySperm & semenGI ComplicationsGastric motility is slowedAbdominal bloating and fullnessAbdominal pain and constipationIntestinal mucosa thins out & decreases enzyme productionTears and inflammation of GI tractThinning of mucosa ↑ risk of ulcersExacerbated with: Anti-inflammatories excessive gum chewing excessive coffeeRefeeding SyndromeSevere shifts in fluid and electrolyte levels from extracellular to intracellular spacesMore recent definition: electrolyte and fluid abnormalities, altered glucose metabolism, vitamin and mineral deficiencies, and associated complications involving the cardiovascular, pulmonary, neuromuscular, and hematologic systems that can occur when a patient who has lost weight is refed orally, enterally, or parenterallyPhosphorousPotassiumMagnesiumRefeeding Syndrome, cont.Causes:During starvation kidneys keep serum lytes stableRefeeding stops the compensation Glucose halts gluconeogenesis & increases insulinP04, K+ & Mg follow glucoseMay cause low thiaminNa+ & water retentionUsually occurs in those @ < 70% IBWMore severe = higher risk of RSRefeeding Syndrome, cont.May result in:Cardiac, neuromuscular, hematological & respiratory dysfx.Congestive heart failureArrhythmiasDelirium, seizures, comaMuscle weaknessImmune dysfunctionDeathPrevention requires slow initial refeedingStart at REE (or below) plus 200-250 kcals q 2-3 dGoal: 2-3 lbs/wkOral P04Closely monitor lytes and P04Christina28 y.o. white female, 66”, 60 lbsh/o significant wt loss prior to college graduation.Now preparing to graduate from nursing school. Extreme emaciation.Refeeding syndromeVery slow to gain weight despite building up to 4000 kcals/d in 6 weeksStacey42 y.o. white female, 82 lbs, 64“h/o AN for 20 years. Husband’s daughter just had a baby girl. They now live with patient and husband.Registered dietitianC/o extreme dizziness & POTS upon standingLab values: low Glu, Mg, Ca, P04, Cl-Normal: Na+, K+, Cr, AlbVomitingLargely ineffective for body fat lossDehydration & electrolyte imbalanceEsophagitis and esophagus tearsEsophageal & stomach ulcersErosion of tooth enamel/risk of cariesFinger calluses and abrasionsMetabolic alkalosisIpecac SyrupMyocarditisCardiomyopathyDiureticsDehydrationWeight re-gained when stoppedElectrolyte imbalance (K+, Na-)Cardiac arrhythmiaHard to thermo-regulateLaxativesWt loss primarily water & food residueDehydration & electrolyte imbalanceCardiac arrhythmiaDamage to lining of intestinesDependence Metabolic acidosisExcessive ExerciseRisk of:Staleness, chronic fatigueIllnesses: depressed immune systemOveruse injuriesMenstrual dysfunctionDiet PillsRapid heart rate, arrhythmiaAnxiety, nervousnessInsomnia or disrupted sleepDehydrationAppetite suppression only temporary- wt re-gain is likelyAddictiveSaunasDehydration; wt quickly regainedElectrolyte imbalancesImpaired thermo-regulationRisk of cardiac arrhythmiaJillian24 y.o. white female, 65”, 120 lbsBulimic, h/o ETOH addiction 6 mos priorWorks 3 jobs: lab tech, dog walker & night vet ER supervisor. Aerobic exercise 60 min dailyExpensive lifestyle: new car, large apartment in Marin“No time to eat during the day”. Stop at 6 different fast food restaurants after work, 11 pm. Binge/purge until 3 am. Up at 7am.Wants to “normalize eating” ................
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