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Eating disorders

Children's Wisconsin: (inpatient) hospital admission criteria for medical stabilization if one or more criteria present

- Malnutrition

  • Weight
  • Patient eating <500 cal/day for last 3 days
  • Rapid weight loss of >5% of body weight within 10 days before admission  
  • Acute food refusal  

- Cardiac Abnormalities 

  • Heart rate <45/min  
  • Cardiac arrhythmias, including prolonged QTc (If prolonged QTc exists, the patient will be admitted to the ICU for cardiac monitoring)  
  • Hypotension for age and sex or blood pressure <80/50mm hg  
  • Orthostatic changes in pulse (sustained increased >40 bpm in teens aged <19 years or sustained drop of blood pressure >20 mmHg systolic or >10 mmHg diastolic) 

- Electrolyte Abnormalities 

  • Hypokalemia (<3.0 mEq/L) (If IV K+ is required, the patient will be admitted to the ICU)  
  • Hypophosphatemia (<2.5 mg/dL)  
  • Hypochloremia (<88 mEq/L)  
  • Metabolic Acidosis/ Ketosis

- Hypothermia (temp. <96 F)  

- Acute medical complications of malnutrition (e.g., syncope, seizures, cardiac failure, pancreatitis, etc.)  

- Acute psychiatric emergencies (e.g., suicidal ideation, acute psychosis) leading to medical instability 

- Co-morbid diagnosis (e.g., severe depression, obsessive-compulsive disorder, severe family dysfunction) leading to medical instability 

- Failure of Outpatient Treatment leading to medical instability as noted above 

- Arrested growth and development

- Uncontrolled binge eating or purging

*Consider the following question:  Are you expecting this aged child to lose weight or fall off the height curve?  Example:  9-12 year old children may not fit the admission criteria but still may need to be admitted.

Children's Wisconsin hospital admission

If the patient has been seen in the last 24 hours AND
Meets the criteria for admission (prior section)

Referral for hospitalization goes through the CW referral line (for direct admits seen within the last 24 hours) or through Children’s ED (if not seen within the last 24 hours) 

Admission work-up (labs and tests)

1. CBC
2. CMP
3. Mg
4. Phosphate
5. TSH
6. Amylase
7. ESR
8. Pre-albumin
9. UA
10. EKG
11. Patient without prior eating disorder diagnosis:  consider differential for presenting symptoms

Children's Wisconsin: calculation for "%IBW"

1. Input patient information into CDC Growth Calculator for 2 to 20 years:  https://peditools.org/growthpedi/ and click “submit”
2. Locate BMI at the 50%ile for age.

ibw chart
3. 50th%ile BMI x height (M2) = IBW(kg)
4. Current weight (kg) / IBW (kg) x 100 = %IBW