Severe Anorexia Nervosa with Critical Weight Loss - Emergency Intervention Case
Case at a Glance
A 21-year-old female presenting with severe anorexia nervosa relapse, critically low BMI of 12.7, engaging in excessive exercise and occupational activity despite medical instability. Patient demonstrates insight into her deteriorating condition but faces systemic barriers to appropriate inpatient care.
Patient's Story
The patient reported experiencing an anorexia nervosa relapse with current weight of 35.6kg at height 168cm (BMI 12.7). She described engaging in intensive daily cardiovascular exercise, working shifts at a retail establishment, and walking excessively (>25,000 steps daily). Patient expressed fear about her body's ability to sustain current demands and concern about not waking up. She reported feeling overwhelmed about initiating recovery steps despite recognizing the severity of her condition. Patient has been under outpatient eating disorder team care for over 7 years with limited treatment resources available due to normal laboratory and ECG results at time of assessment.
Initial Assessment
Patient presented with critically low BMI of 12.7 in context of anorexia nervosa relapse. Vital signs revealed bradycardia with resting heart rate of 41 bpm. Recent emergency department visit resulted in discharge despite critical presentation. Laboratory studies and ECG performed Friday prior to consultation were reportedly within normal limits. Patient demonstrated preserved occupational and physical functioning despite severe underweight status.
The Diagnostic Journey
Patient had been receiving outpatient eating disorder treatment for over 7 years with documented weight loss of 2.7kg over previous two months. Multiple healthcare encounters including recent emergency department visit failed to result in appropriate inpatient admission despite meeting medical emergency criteria per established eating disorder guidelines (MEED 2022, IAEM Clinical Guidelines).
Final Diagnosis
Severe Anorexia Nervosa with medical instability, meeting criteria for high impending risk to life. Secondary diagnoses include exercise-induced bradycardia in context of severe malnutrition and high risk for refeeding syndrome.
Treatment Plan
Immediate medical stabilization with inpatient hospitalization recommended despite normal laboratory values, given critically low BMI and excessive exercise pattern. Nutritional rehabilitation with careful refeeding protocol to prevent refeeding syndrome. Psychiatric intervention for eating disorder treatment. Coordination with specialized eating disorder treatment team for comprehensive care approach. Patient scheduled for urgent outpatient team evaluation within 24 hours of initial presentation.
Outcome and Follow-up
Patient acknowledged need for intervention and scheduled follow-up appointment with outpatient eating disorder team. Case highlights systemic gaps in eating disorder treatment access and need for healthcare provider education regarding medical emergency criteria in eating disorders independent of laboratory values. Long-term prognosis dependent on access to appropriate level of care and intensive treatment intervention.