Bulemia, Treatment

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Treatment

Emergency Department Care

Comprehensive guidelines for the management of bulimia nervosa are provided by the American Psychiatric Association,?Practice Guidelines for the Treatment of Patients With Eating Disorders, Third Edition.

Complications of bulimia treatable in the emergency setting may include volume depletion, electrolyte abnormalities, esophagitis, Mallory-Weiss tear, esophageal or gastric rupture, pancreatitis, arrhythmias, or adverse effects of medication (eg, ipecac, appetite suppressants).
Associated illnesses, including depression, anxiety disorders, and substance abuse, increase the risk of other illness and injury. Directly question patients regarding suicidal ideation.
Patients should be warned against the use of diet pills and amphetamines, as well as energy pills and diet teas that claim to be all-natural. All-natural supplements often contain herbal forms of caffeine and ephedrine and have been associated with hypertension and cerebrovascular accident.
As new therapies to treat bulimia are introduced, considering possible adverse effects from these new therapies is important. Possible adverse effects may include renal lithiasis, glaucoma, seizure, and metabolic derangements.
Patients with eating disorders who are seen for an apparently unrelated problem benefit from an emergency physician who recognizes an eating disorder and provides initial management and suitable referral.

Consultations

For patients who are unable to halt the dangerous sequence of dieting, binging, and purging, admission to a psychiatric unit may be necessary to break the cycle.?
Psychiatric hospitalization may also be necessary for patients with severe depression and suicidal ideation, weight loss greater than 30% over 3 months, failure to maintain outpatient weight contract, or family crisis.??
Admission to a medical facility is warranted for patients with significant electrolyte/metabolic disturbance or other physical complication of binging or purging (eg, Mallory-Weiss tear, esophageal rupture, pancreatitis).?
All patients suspected of having an eating disorder should be referred to a psychiatrist for further evaluation. If possible, arrangements should be made for follow-up within 2 days.

Bulemia, TreatmentOriginally from: http://www.nursinglink.monster.com/news/articles/15238-bulemia-treatment

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