Refeeding syndrome in anorexia nervosa
|
|
- Roderick Holt
- 3 years ago
- Views:
Transcription
1 ESPEN Congress Barcelona 2012 Is there a role for nutrition in psychiatric disorders? Refeeding syndrome in anorexia nervosa V. Haas (Germany)
2 ESPEN Barcelona The refeeding syndrome in Anorexia Nervosa Dr. oec. troph. Verena Haas Department of Child and adolescent Psychiatry, Psychosomatics and Psychotherapy Experminental and Clinical Research Center (ECRC) U N I V E R S I T Ä T S M E D I Z I N B E R L I N
3 Case report 1 15-year-old girl, 2.5 years history of weight loss (-20kg; dieting, exercising) Admission BMI 11.6 kg/m 2 (30 kg), ankle edema, bradycardia Fear of weight gain, body image distortion Secondary amenorrhea Oriented and alert, anxious, tense Low P (0.78 mmol/l) and glc (2.6 mmol/l), other electrolytes normal Meal plan: 800 kcal/d orally with progressive increase incl. P, Ca, vitamins P remained low despite supplementation Day 4: fluctuating levels of consciousness, confused, slow speech Day 6 (1000 kcal/d): worsening of mental status; disoriented, incoherent speech, paranoid ideas, repetitive movements, agitated, aggressive, uncooperative Till day 13: fluctuating mental status Day 15: back to her normal self 1 Norris et al., Int J Eat Disord 2012;45:
4 The Refeeding Syndrome (RS) History adult war or famine victims WW2 healthy volunteers after experimental starvation (Minnesota study, 1960) In the 1970s following the introduction of TPN Definitions occurrence of severe fluid & electrolyte shifts (especially, but not exclusively, of P) and their associated complications in malnourished patients undergoing refeeding 2 Range of metabolic abnormalities that may accompany carbohydrate delivery in patients with severe malnutrition 3 Fall in phosphate by more than 0.16 to below or to below 0.5 mmol/l 5 2 Solomon & Kirkby, J Parenter Enetral Nutr 1990; 3 Norris et al., Int J Eat Disord 2012;45: Marik et al., Surg 1996;131: Hearing, BMJ 2004;328:908-9.
5 Metabolic consequences of the RS include: Key: Hypophosphataemia Hypokalaemia Hypomagnesaemia Fluid and sodium balance abnormalities Pathophysiological consequences include: Cardiac failure Neuromuscular failure Respiratory failure Renal failure Hepatic failure Gastrointestinal System Failure
6 The Refeeding Syndrome (RS): Mechanisms 6-8 Prolonged Fasting Gluconeogenesis from lipids & protein Intracellular & WB minerals depleted Refeeding: CH load RS Clinical features of functional electrolyte deficits Risk of sudden death on Low basal insulin Delayed insulin response Glycogen, fat & protein synthesis Sudden move of electrolytes & fluid into intracellular space Hypoglycemia, hypophosphatemia 6 Kohn et al., Curr Opin Pediatr 2011;23: Mehanna et al., BMJ 2008;336: Crook et al., Nutrition 2001;17:632-7.
7 Occurence True incidence unknown 7 AN: case reports 1 Guidelines: No published RCTs of treatment, best available evidence 7, L. Sobotka: Refeeding Syndrome. ESPEN guidelines (2006) Blue book : NICE Guidelines (National Institute for Health and Clinical Excellence, CG32) 11 Kraft et al.: Review of the RS. Nutr Clin Pract Patients at high risk of refeeding syndrome: Anorexia Nervosa Chronic alcoholism Oncology patients Postoperative patients Chronic malnutrition 7 Mehanna et al., BMJ 2008;336: Norris et al., Int J Eat Disord 2012;45: O Connor et al., Int J Eat Disord 2011;44:182-5.
8 Prevention of the RS 7, clinical experience AN patient on admission: Check baseline P, K, Mg, Na, Ca, Glc and liver enzymes risk if Low P BMI < 15, negligible intake for > 5 days Purging behavior, long duration of illness If P < 0.8 or decreases (i.e. from 1.2 to 0.9) Administer thiamine, multi-vitamines and trace elements Start feeding slowly ( kcal/d; 25% of estimated needs) Week 1: daily blood tests /electrolytes hydration, sodium intake Check vital signs, observe signs of delirium or edema Tube feeding gives better control Slowly increase feeding over 3-7 days, Week 2: at least 3 blood tests Tailor to individual patient & course!
9 Ideal mode of supplementation not known 7 If signs of RS occur 1,10*** Immediate interruption of nutrition support Respiratory and cardiac care Resolve fluid shifts and electrolyte disorders*** Supportive care (low stimulus environment, orientation help, family support) Restart nutrition with at <50% of last rate once patient is stable Close monitoring
10 Recent advances: restricting CH instead of calories 6 Current protocols do not eliminate RS and result in weight loss until 2 nd week Questionable if RS preventable by restricting calories Key factor: carbohydrate load and postprandial hypoglycemia Alternative strategy increase cal limit CH maintain normal P Modified refeeding guidelines: (1) Continuous NG feeding at the beginning of treatment (2) Minimum initial daily energy intake of 2000 kcal (3) Feeds and meal plan limited to a maximum of 40% of total energy from CH (4) Oral P mg/kg daily in 2 doses (5) By end of week 1: daily intake of 2700 kcal (6) Reintroduction of oral food once medically stable (7) Monitoring vital signs and daily blood tests during week 1 of treatment 6 Kohn et al., Curr Opin Pediatr 2011;23:390-4.
11 How to achieve prolonged, steady weight gain after initial phase? Target: kg/week Limited knowledge on caloric needs Guidelines: kcal/d sufficient for most adolescent patients 13 Individual variation between 1800 and 4500 kcal Guidelines for the nutritional management of AN, Royal College of Physicians, London, Mehler et al.: Nutritional rehabilitation: practical guidelines for refeeding the anorectic patient. J Nutr Metab 2010.
12 Summary RS is a well described but often forgotten condition RS can be lethal The best way to avoid it is to anticipate it Refeeding guidelines are available: NICE 2006 ESPEN 2005 but they are not evidence based A future alternative might be to target CHs instead of calories
13 ESPEN Barcelona The refeeding syndrome in Anorexia Nervosa Thank you for your attention! Address of correspondence: U N I V E R S I T Ä T S M E D I Z I N B E R L I N
Eating Disorders: Anorexia Nervosa and Bulimia Nervosa Preferred Practice Guideline
Introduction Eating Disorders are described as severe disturbances in eating behavior which manifest as refusal to maintain a minimally normal body weight (Anorexia Nervosa) or repeated episodes of binge
Nutritional Rehabilitation for Patients Diagnosed with Anorexia Nervosa
Nutritional Rehabilitation for Patients Diagnosed with Anorexia Nervosa Brooke Peysar and Sarah Thomas May 2014 Introduction Eating disorders are becoming more and more prevalent in our society. Whether
Children s Hospital at Westmead Eating Disorder Inpatient Program
Appendix Children s Hospital at Westmead Eating Disorder Inpatient Program Michael R. Kohn The eating disorder program at the hospital combines the expertise of the Departments of Adolescent Medicine and
Diagnosis: Appropriate diagnosis is made according to diagnostic criteria in the current Diagnostic and Statistical Manual of Mental Disorders.
Page 1 of 6 Approved: Mary Engrav, MD Date: 05/27/2015 Description: Eating disorders are illnesses having to do with disturbances in eating behaviors, especially the consuming of food in inappropriate
In-text Figure Page 310. Lecture 19: Eating disorders and disordered eating. Eating Disorders. Eating Disorders. Nutrition 150 Shallin Busch, Ph.D.
Lecture 19: Eating disorders and disordered eating In-text Figure Page 310 Nutrition 150 Shallin Busch, Ph.D. Eating Disorders Eating Disorders Determining an eating disorder first requires a definitions
The medical risk arises from a combination of the restrictive behaviours (food and in some cases fluid) and the compensatory behaviours.
www.eatingresearch.com from the Section of Eating Disorders at the Institute of Psychiatry and the Eating Disorders Unit at SLaM A GUIDE TO THE MEDICAL RISK ASSESSMENT FOR EATING DISORDERS by Professor
Laboratory Monitoring of Adult Hospital Patients Receiving Parenteral Nutrition
Laboratory Monitoring of Adult Hospital Patients Receiving Parenteral Nutrition Copy 1 Location of copies Web based only The following guideline is for use by medical staff caring for the patient and members
Nutrition Assessment. Miranda Kramer, RN, MS Nurse Practitioner/Clinical Nurse Specialist
Nutrition Assessment Miranda Kramer, RN, MS Nurse Practitioner/Clinical Nurse Specialist General Considerations Overall caloric intake is it enough, too little or too much? What s in our calories fats,
Why learn about Eating Disorders?
New Horizons: eating disorders in Children and Adolescents Anna B. Tanner, MD, FAAP, FSAHM, CEDS The Teen Center at GPAM, Gwinnett Pediatrics and Adolescent Medicine Adjunct Assistant Professor of Pediatrics,
Nutritional Support of the Burn Patient
Nutritional Support of the Burn Patient Objectives To understand the principles of normal nutrient utilization and the abnormalities caused by burn injury To be able to assess nutrient needs To be able
Review Group: Mental Health Operational Medicines Management Group. Signature Signature Signature. Review Date: December 2014
Mental Health NHS Grampian Mental Health Service Staff Guidance For The Prescribing Of Vitamin Supplementation During In-Patient Admission (Mental Health) For Alcohol Withdrawal Co-ordinators: Consultant
8.201 Acute Inpatient Eating Disorder (Adult and Adolescent)
8.20 INPATIENT SERVICES 8.201 Acute Inpatient Eating Disorder (Adult and Adolescent) Description of Services: Acute inpatient eating disorder treatment represents the most intensive level of psychiatric
Bariatric Patients, Nutritional Intervention for
SKILL COMPETENCY CHECKLIST Bariatric Patients, Nutritional Intervention for Link to Dietitian Practice and Skill Standard Met/Initials Prerequisite Skills Competency Areas Knowledge of how to conduct a
Liver, Gallbladder, Exocrine Pancreas KNH 406
Liver, Gallbladder, Exocrine Pancreas KNH 406 2007 Thomson - Wadsworth LIVER Anatomy - functions With disease blood flow becomes obstructed Bile All bile drains into common hepatic duct Liver Bile complex
Applying the 2016 ASPEN/ SCCM Critical Care Guidelines to Your Practice. Susan Brantley, MS, RD, LDN
Applying the 2016 ASPEN/ SCCM Critical Care Guidelines to Your Practice Susan Brantley, MS, RD, LDN Objectives: Upon completion of this presentation, participants should be able to: 1. Distinguish the
CARDIAC SURGERY INTRAVENOUS INSULIN PROTOCOL PHYSICIAN ORDERS INDICATIONS EXCLUSIONS. Insulin allergy
Page 1 of 5 INDICATIONS EXCLUSIONS 2 consecutive blood glucose measurements greater than 110 mg per dl AND NPO with a continuous caloric source AND Diagnosis of : Cardio-thoracic Surgery NOTE: This protocol
Formulary and Prescribing Guidelines
Formulary and Prescribing Guidelines SECTION 15: TREATMENT OF EATING DISORDERS Section 15. Treatment of eating disorders 15.1 Introduction Please review the Trust document Guidelines for the assessment
INPATIENT DIABETES MANAGEMENT Robert J. Rushakoff, MD Professor of Medicine Director, Inpatient Diabetes University of California, San Francisco
INPATIENT DIABETES MANAGEMENT Robert J. Rushakoff, MD Professor of Medicine Director, Inpatient Diabetes University of California, San Francisco CLINICAL RECOGNITION Background: Appropriate inpatient glycemic
NUTRITION OF THE BODY
5 Training Objectives:! Knowledge of the most important function of nutrients! Description of both, mechanism and function of gluconeogenesis! Knowledge of the difference between essential and conditionally
A guide to admission and inpatient treatment for people with eating disorders at the Royal Brisbane and Women s Hospital
Royal Brisbane and Women s Hospital Mental Health Eating Disorders Outreach Service (EDOS) A guide to admission and inpatient treatment for people with eating disorders at the Royal Brisbane and Women
ETIOLOGIC CLASSIFICATION. Type I diabetes Type II diabetes
DIABETES MELLITUS DEFINITION It is a common, chronic, metabolic syndrome characterized by hyperglycemia as a cardinal biochemical feature. Resulting from absolute lack of insulin. Abnormal metabolism of
483.25(i) Nutrition (F325) Surveyor Training: Interpretive Guidance Investigative Protocol
483.25(i) Nutrition (F325) Surveyor Training: 1 With regard to the revised guidance F325 Nutrition, there have been significant changes. Specifically, F325 and F326 were merged. However, the regulatory
Over 50% of hospitalized patients are malnourished. Coding for Malnutrition in the Adult Patient: What the Physician Needs to Know
Carol Rees Parrish, M.S., R.D., Series Editor Coding for Malnutrition in the Adult Patient: What the Physician Needs to Know Wendy Phillips At least half of all hospitalized patients are malnourished,
8.301 Residential Treatment Services (RTS) Eating Disorders (Adult and Adolescent)
8.30 RESIDENTIAL TREATMENT CENTER SERVICES 8.301 Residential Treatment Services (RTS) Eating Disorders (Adult and Adolescent) Description of Services: Residential Treatment Services are provided to individuals
Enteral Nutrition as a Life-Saving Treatment in Patients with Severe Anorexia Nervosa
17 Enteral Nutrition as a Life-Saving Treatment in Patients with Severe Anorexia Nervosa Maria Gabriella Gentile Eating Disorder Unit, Niguarda Hospital, Milan, Italy 1. Introduction Anorexia Nervosa is
2. What Should Advocates Know About Diabetes? O
2. What Should Advocates Know About Diabetes? O ften a school district s failure to properly address the needs of a student with diabetes is due not to bad faith, but to ignorance or a lack of accurate
嘉 義 長 庚 醫 院 藥 劑 科 Speaker : 翁 玟 雯
The Clinical Efficacy and Safety of Sodium Glucose Cotransporter-2 (SGLT2) Inhibitors in Adults with Type 2 Diabetes Mellitus 嘉 義 長 庚 醫 院 藥 劑 科 Speaker : 翁 玟 雯 Diabetes Mellitus : A group of diseases characterized
TOTAL PARENTERAL NUTRITION (TPN) Revised January 2013
TOTAL PARENTERAL NUTRITION (TPN) Revised January 2013 OBJECTIVES Definition Indications for TPN administration Composition of TPN solutions Access routes for TPN administration Monitoring TPN administration
Dietary treatment of cachexia challenges of nutritional research in cancer patients
Dietary treatment of cachexia challenges of nutritional research in cancer patients Trude R. Balstad 4th International Seminar of the PRC and EAPC RN, Amsterdam 2014 Outline Cancer cachexia Dietary treatment
8.401 Eating Disorder Partial Hospitalization Program (Adult and Adolescent)
8.40 STRUCTURED DAY TREATMENT SERVICES 8.401 Eating Disorder Partial Hospitalization Program (Adult and Adolescent) Description of Services: Eating Disorder partial hospitalization is a nonresidential
FAILURE TO THRIVE What Is Failure to Thrive?
FAILURE TO THRIVE The first few years of life are a time when most children gain weight and grow much more rapidly than they will later on. Sometimes, however, babies and children don't meet expected standards
Type 1 diabetes and eating disorders
Type 1 diabetes and eating disorders The National Diabetes Services Scheme (NDSS) is an initiative of the Australian Government administered by Diabetes Australia. 1 Eating disorders are a considerable
ENTERAL FORMULAE AND PARENTERAL NUTRITIONAL SOLUTIONS, DME
ENTERAL FORMULAE AND PARENTERAL NUTRITIONAL SOLUTIONS, DME Policy NHP only reimburses participating DME vendors for the provision of medically necessary enteral and parenteral formulae and nutritional
Regulation of Metabolism. By Dr. Carmen Rexach Physiology Mt San Antonio College
Regulation of Metabolism By Dr. Carmen Rexach Physiology Mt San Antonio College Energy Constant need in living cells Measured in kcal carbohydrates and proteins = 4kcal/g Fats = 9kcal/g Most diets are
Diabetes at the End of Life. Dr David Kerr MD Bournemouth Diabetes and Endocrine Centre www.b-dec.co.uk
Diabetes at the End of Life Dr David Kerr MD Bournemouth Diabetes and Endocrine Centre www.b-dec.co.uk A good way to live longer is to move to the eastern part of the English county of Dorset and take
Guide to Eating Disorder Recovery/Treatment Care Team Planning
Guide to Eating Disorder Recovery/Treatment Care Team Planning - For clinicians working with clients with Anorexia Nervosa and other severe eating disorder presentations - To be used after assessment and
Version 2 This guideline describes how to manage patients who are showing signs and symptoms of alcohol withdrawal and Wernicke s Encephalopathy.
Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Contact Name and Job Title (author) Directorate & Speciality A Guideline for the Management of Acute Alcohol Withdrawal
Diabetes Management Tube Feeding/Parenteral Nutrition Order Set (Adult)
Review Due Date: 2016 May PATIENT CARE ORDERS Weight (kg) Known Adverse Reactions or Intolerances DRUG No Yes (list) FOOD No Yes (list) LATEX No Yes ***See Suggestions for Management (on reverse)*** ***If
Level 3. Applying the Principles of Nutrition to a Physical Activity Programme Level 3
MULTIPLE CHOICE QUESTION PAPER Paper number APNU3.0 Please insert this reference number in the appropriate boxes on your candidate answer sheet Title MOCK PAPER Time allocation 50 minutes Level 3 Applying
Reversing type 2 diabetes: pancreas composition and function during return to normal glucose tolerance
Reversing type 2 diabetes: pancreas composition and function during return to normal glucose tolerance Dr Sarah Steven Clinical Research Fellow to Professor Roy Taylor Observations from bariatric surgery
Diabetic Ketoacidosis: When Sugar Isn t Sweet!!!
Diabetic Ketoacidosis: When Sugar Isn t Sweet!!! W Ricks Hanna Jr MD Assistant Professor of Pediatrics University of Tennessee Health Science Center LeBonheur Children s Hospital Introduction Diabetes
YOUR LAST DIET IDEAL PROTEIN
YOUR LAST DIET IDEAL PROTEIN OBJECTIVES Explain the science and history that supports the Ideal Protein Diet method. Describe the risks and benefits of diet participation. Give you the details of what
North of Tyne Area Prescribing Committee
North of Tyne Area Prescribing Committee ANTIPSYCHOTICS IN PSYCHOSIS, BIPOLAR DISORDER AND AUGMENTATION THERAPY IN TREATMENT RESISTANT DEPRESSION Information for Primary Care Updated November 2013 This
Abdulaziz Al-Subaie. Anfal Al-Shalwi
Abdulaziz Al-Subaie Anfal Al-Shalwi Introduction what is diabetes mellitus? A chronic metabolic disorder characterized by high blood glucose level caused by insulin deficiency and sometimes accompanied
23/06/2014. Nutrition in Chronic Liver Disease. Objectives. Question #1
Nutrition in Chronic Liver Disease Maitreyi Raman, MD, FRCPC Clinical Associate Professor University of Calgary April 2014 Objectives 1. Describe contributing factors toward malnutrition in advanced liver
Overview. Nutritional Aspects of Primary Biliary Cirrhosis. How does the liver affect nutritional status?
Overview Nutritional Aspects of Primary Biliary Cirrhosis Tracy Burch, RD, CNSD Kovler Organ Transplant Center Northwestern Memorial Hospital Importance of nutrition therapy in PBC Incidence and pertinence
PREOPERATIVE MANAGEMENT FOR BARIATRIC PATIENTS. Adrienne R. Gomez, MD Bariatric Physician St. Vincent Bariatric Center of Excellence
PREOPERATIVE MANAGEMENT FOR BARIATRIC PATIENTS Adrienne R. Gomez, MD Bariatric Physician St. Vincent Bariatric Center of Excellence BARIATRIC SURGERY Over 200,000 bariatric surgical procedures are performed
NUTRITION IN LIVER DISEASES
NUTRITION IN LIVER DISEASES 1. HEPATITIS: Definition: - Viral inflammation of liver cells. Types: a. HAV& HEV, transmitted by fecal-oral route. b. HBV & HCV, transmitted by blood and body fluids. c. HDV
Nutrition Management After Bariatric Surgery
Nutrition Management After Bariatric Surgery Federal Bureau of Prisons Clinical Practice Guidelines October 2013 Clinical guidelines are made available to the public for informational purposes only. The
The University of Hong Kong Department of Surgery Division of Esophageal and Upper Gastrointestinal Surgery
Program Overview The University of Hong Kong Department of Surgery Division of Esophageal and Upper Gastrointestinal Surgery Weight Control and Metabolic Surgery Program The Weight Control and Metabolic
Levels of Care in Eating Disorder Treatment. A part of the Parent, Family & Friends Network (PFN) Webinar Series
Levels of Care in Eating Disorder Treatment A part of the Parent, Family & Friends Network (PFN) Webinar Series Meet the Presenter Zoë Bisbing, LCSW Licensed therapist and member of the treatment team
Obesity Affects Quality of Life
Obesity Obesity is a serious health epidemic. Obesity is a condition characterized by excessive body fat, genetic and environmental factors. Obesity increases the likelihood of certain diseases and other
UCSF Kidney Transplant Symposium 2012
UCSF Kidney Transplant Symposium 2012 Nutrition Fitness in Kidney Transplant Mary Ellen DiPaola, RD, CDE UCSF Outpatient Dietitian Goal of Nutrition Fitness for Transplant Nutritional guidance of pre-
FORMULA & SPECIALIZED FOOD
FORMULA & SPECIALIZED FOOD ADMINISTRATIVE POLICY Policy Number: HOME 005.16 T2 Effective Date: December 1, 2014 Table of Contents CONDITIONS OF COVERAGE... COVERAGE RATIONALE BENEFIT CONSIDERATIONS...
Presentation Notes Maintaining a Healthy Digestive System
Slide 1 Maintaining a Healthy Digestive System 1 Slide 2 Copyright Copyright Texas Education Agency, 2011. These Materials are copyrighted and trademarked as the property of the Texas Education Agency
Paediatric fluids 13/06/05
Dr Catharine Wilson Consultant Paediatric Anaesthetist Sheffield Children s Hospital. UK Paediatric fluids 13/06/05 Self assessment: Complete these questions before reading the tutorial. Discuss the answers
Diabetes Expert Witness on: Diabetic Hypoglycemia in Nursing Homes
Diabetes Expert Witness on: Diabetic Hypoglycemia in Nursing Homes Nursing home patients with diabetes treated with insulin and certain oral diabetes medications (i.e. sulfonylureas and glitinides) are
Sowbhagya B S, Physical Education Director, Government First Grade College, Tumkur District, Karnataka state
Sowbhagya B S, Physical Education Director, Government First Grade College, Tumkur District, Karnataka state Supplemental nutrition drinks can be supportive to players. Studies have shown that minerals
Nutrition Requirements
Who is responsible for setting nutrition requirements in the UK? In the UK we have a set of Dietary Reference Values (DRVs). DRVs are a series of estimates of the energy and nutritional requirements of
Frequently Asked Questions: Gastric Bypass Surgery at CMC
Frequently Asked Questions: Gastric Bypass Surgery at CMC Please feel free to talk with any member of the Obesity Treatment Center team at Catholic Medical Center regarding any questions, concerns or comments
TPN origin and calculations. Naureen Iqbal 01/09/13
TPN origin and calculations Naureen Iqbal 01/09/13 TPN - History Glucose and electrolyte Protein hydrolysates in 30s Fat emulsion- Intralipid in 60s. Vitamins, minerals, trace elements Central venous catheter
PAGE 1 OF 5 ISSUED: JULY 07, 2010 REVISED:
HALIFAX FIRE DEPARTMENT R&R ARTICLE 21 HOT WEATHER OPERATIONS GUILDLINES PAGE 1 OF 5 ISSUED: JULY 07, 2010 REVISED: Purpose This policy provides a method of action to guide firefighting personnel in the
Lothian Diabetes Handbook MANAGEMENT OF DIABETIC KETOACIDOSIS
MANAGEMENT OF DIABETIC KETOACIDOSIS 90 MANAGEMENT OF DIABETIC KETOACIDOSIS Diagnosis elevated plasma and/or urinary ketones metabolic acidosis (raised H + /low serum bicarbonate) Remember that hyperglycaemia,
Macronutrient and Energy Intake After Bariatric Surgery
Macronutrient and Energy Intake After Bariatric Surgery What do we know today? Jacqueline Jacques, ND, FTOS Newport Beach, CA USA Disclosure Jacqueline Jacques, ND, FTOS Thorne Research, Inc Salary Senior
Meal Supervision and Support in an Eating Disorders Inpatient Program
Meal Supervision and Support in an Eating Disorders Inpatient Program Rachel Barbara Eating Disorders Consultant Victorian Centre of Excellence in Eating Disorders Introduction Normalizing eating behaviour
EFFIMET 1000 XR Metformin Hydrochloride extended release tablet
BRAND NAME: Effimet XR. THERAPEUTIC CATEGORY: Anti-Diabetic PHARMACOLOGIC CLASS: Biguanides EFFIMET 1000 XR Metformin Hydrochloride extended release tablet COMPOSITION AND PRESENTATION Composition Each
Bulimia Nervosa. This reference summary explains bulimia. It covers symptoms and causes of the condition, as well as treatment options.
Bulimia Nervosa Introduction Bulimia nervosa, or bulimia, is an eating disorder. A person with bulimia eats a large amount of food in a short amount of time. To prevent weight gain, the person then purges.
ICD-9-CM/ICD-10-CM Codes for MNT
/ Codes for MNT ICD (International Classification of Diseases) codes are used by physicians and medical coders to assign medical diagnoses to individual patients. It is not within the scope of practice
Nutrition management in liver diseases
Nutrition management in liver diseases Assist Profess Supawan Buranapin, MD Section of Endocrinology, Department of medicine Faculty of Medicine, Chiang Mai University 9 Feb 2012 The main functions of
NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.
bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published.
Mind the Gap: Navigating the Underground World of DKA. Objectives. Back That Train Up! 9/26/2014
Mind the Gap: Navigating the Underground World of DKA Christina Canfield, MSN, RN, ACNS-BC, CCRN Clinical Nurse Specialist Cleveland Clinic Respiratory Institute Objectives Upon completion of this activity
MANAGEMENT OF LIVER CIRRHOSIS
MANAGEMENT OF LIVER CIRRHOSIS Information Leaflet Your Health. Our Priority. Page 2 of 6 What is cirrhosis? Cirrhosis is a result of long-term, continuous damage to the liver and may be due to many different
Endocrine issues in FA SUSAN R. ROSE CINCINNATI CHILDREN S HOSPITAL MEDICAL CENTER
Endocrine issues in FA SUSAN R. ROSE CINCINNATI CHILDREN S HOSPITAL MEDICAL CENTER 80% of children and adults with FA have an endocrine abnormality Endocrine cells make a hormone (message) Carried in bloodstream
Diabetes and eating disorders
Diabetes and eating disorders The National Diabetes Services Scheme (NDSS) is an initiative of the Australian Government administered by Diabetes Australia. Eating disorders are a considerable issue for
Psychosocial and Clinical Aspects of Eating Disorder in Young Females. Khoo P.J. 1 and Ho T.F. 2
Psychosocial and Clinical Aspects of Eating Disorder in Young Females ABSTRACT Khoo P.J. 1 and Ho T.F. 2 Department of Physiology, Faculty of Medicine, National University of Singapore 10 Kent Ridge Road,
Module 9: Diseases of the Endocrine System and Nutritional Disorders Exercises
Module 9: Diseases of the Endocrine System and Nutritional Disorders Exercises 1. An 86 year old male with brittle Type I DM is admitted for orthopedic surgery. The physician documents in the operative
Eating Disorders Outpatient Treatment
Patient and Family Education Eating Disorders Outpatient Treatment Frequently asked questions Recovery from an eating disorder is a complex process. We want you to ask questions along the way. Here are
What is Type 2 Diabetes?
Type 2 Diabetes What is Type 2 Diabetes? Diabetes is a condition where there is too much glucose in the blood. Our pancreas produces a hormone called insulin. Insulin works to regulate our blood glucose
The Eating Disorder Program The Hospital for Sick Children
The Eating Disorder Program Dear Doctor: Thank-you for your referral to the Eating Disorder Program at. The Eating Disorder Program at provides assessment and treatment for adolescents who suffer from
Causes, incidence, and risk factors
Causes, incidence, and risk factors Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both. To understand diabetes,
Detailed Course Descriptions for the Human Nutrition Program
1 Detailed Course Descriptions for the Human Nutrition Program Major Required Courses NUTR221 Principles of Food Science and Nutrition Credit (Contact) Hours 2 CH(2 Theory) Prerequisites Course Description
GUIDELINES FOR TOTAL PARENTERAL NUTRITION (TPN) IN ADULT BONE MARROW TRANSPLANT PATIENTS
GUIDELINES FOR TOTAL PARENTERAL NUTRITION (TPN) IN ADULT BONE MARROW TRANSPLANT PATIENTS TPN Indications TPN is indicated for any patient who is not expected to eat sufficiently for 3-5 days in severe
INDEPENDENT MENTAL HEALTHCARE PROVIDER. Eating Disorders. Eating. Disorders. Information for Patients and their Families
INDEPENDENT MENTAL HEALTHCARE PROVIDER Eating Disorders CARDINAL CLINIC Eating Disorders Information for Patients and their Families What are Eating Disorders? Eating Disorders are illnesses where there
COMMISSION OF THE EUROPEAN COMMUNITIES
COMMISSION OF THE EUROPEAN COMMUNITIES Brussels SANCO D4/HL/mm/D440182 Working Document for Draft COMMISSION DIRECTIVE on foods intended to meet the expenditure of intense muscular effort, especially for
Guideline for Identification and Management of Eating Disorder Symptoms in Primary Care
Guideline for Identification and Management of Eating Disorder Symptoms in Primary Care This guideline is informational in nature and is not intended to be a substitute for professional clinical judgment.
GLUCOSE HOMEOSTASIS-II: An Overview
GLUCOSE HOMEOSTASIS-II: An Overview University of Papua New Guinea School of Medicine & Health Sciences, Division of Basic Medical Sciences Discipline of Biochemistry & Molecular Biology, M Med Part I
Course Curriculum for Master Degree in Food Science and Technology/ Department of Nutrition and Food Technology
Course Curriculum for Master Degree in Food Science and Technology/ Department of Nutrition and Food Technology The Master Degree in Food Science and Technology / Department of Nutrition and Food Technology,
INTERNAL MEDICINE RESIDENTS NOON CONFERENCE: INPATIENT GLYCEMIC CONTROL
INTERNAL MEDICINE RESIDENTS NOON CONFERENCE: INPATIENT GLYCEMIC CONTROL Presented by: Leyda Callejas PGY5 Endocrinology, Diabetes and Metabolism Acknowledgements: Dr. P Orlander Dr. V Lavis Dr. N Shah
The Under-Recognized Role of Essential Nutrients in Health and Health Care
The Under-Recognized Role of Essential Nutrients in Health and Health Care Honolulu Subarea Health Planning Council February 7, 2013 Joannie Dobbs, Ph.D. CNS Assistant Specialist Human Nutrition, Food
Wound Healing. Outline. Normal Wound Healing. Wounds and nutrition refresher UPHS evidence-based guideline for. wounds
Wound Healing Clinical Nutrition Support Service Hospital of the University of Pennsylvania Jung Kim, RD CNSD, LDN Tricia Stefankiewicz, MA, RD, CNSC, LDN Outline Wounds and nutrition refresher UPHS evidence-based
NPO until Dysphagia Screen
NPO until Dysphagia Screen Nancy B. Swigert, M.A., CCC/SLP, BRS-S Speech-Language Pathologist Board Recognized Specialist in Swallowing and Swallowing Disorders Director Speech-Language Pathology & Respiratory
Omega-3 fatty acids improve the diagnosis-related clinical outcome. Critical Care Medicine April 2006;34(4):972-9
Omega-3 fatty acids improve the diagnosis-related clinical outcome 1 Critical Care Medicine April 2006;34(4):972-9 Volume 34(4), April 2006, pp 972-979 Heller, Axel R. MD, PhD; Rössler, Susann; Litz, Rainer
Guidelines. for Sick Day Management for People with Diabetes
Guidelines for Sick Day Management for People with Diabetes When to Follow Sick Day Guidelines These guidelines apply when the person with diabetes is feeling unwell or noticing signs of an illness and/
PARACETAMOL POISONING
Background Resuscitation Risk Assessment Supportive Care Decontamination Paracetamol Levels Nomogram Antidote N-acetylcysteine (NAC) Table NAC infusion guide Timing of Investigations Risk factors for Paracetamol
DIET AND EXERCISE STRATEGIES FOR WEIGHT LOSS AND WEIGHT MAINTENANCE
DIET AND EXERCISE STRATEGIES FOR WEIGHT LOSS AND WEIGHT MAINTENANCE 40 yo woman, BMI 36. Motivated to begin diet therapy. Which of the following is contraindicated: Robert B. Baron MD MS Professor and
Age Appropriate Care Through the Life Span
Age Appropriate Care Through the Life Span The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) requires that any healthcare providers who have patient contact be competent in
CR162. MARSIPAN: Management of Really Sick Patients with Anorexia Nervosa. October 2010 COLLEGE REPORT
CR162 MARSIPAN: Management of Really Sick Patients with Anorexia Nervosa October 2010 COLLEGE REPORT MARSIPAN: Management of Really Sick Patients with Anorexia Nervosa Report from the MARSIPAN group College
Diabetic Emergencies. David Hill, D.O.
Diabetic Emergencies David Hill, D.O. Class Outline Diabetic emergency/glucometer training Identify the different signs of insulin shock Diabetic coma, and HHNK Participants will understand the treatment
New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery
New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery USING THE 48 HOUR OBSERVATION BED USING THE 48 HOUR OBSERVATION BED Detoxification