SAQ 213 – Mental Health and Electrolytes – anorexia nervosa with hypokalaemia

Question 2. anorexia nervosa with hypokalaemia.

a. Diagnostic components

• Self-induced weight loss or restriction of energy intake.
• Body weight significantly below expected or BMI below 17.5.
• Intense fear of gaining weight or becoming fat.
• Body-image distortion.

b. Examination findings

• Height, weight, and BMI.
• Loss of subcutaneous fat.
• Hypotension.
• Bradycardia.
• Hypothermia.
• Signs of cardiac failure or poor perfusion.
• Hair loss, dental enamel loss, parotid swelling, poor healing, self-harm, weakness, or hyporeflexia.

c. Factors favouring IV replacement

• Extreme weakness.
• Cardiac arrhythmia.
• Dehydration requiring IV therapy.
• Vomiting or inability to tolerate oral treatment.

d. Route comparison

e. Attempted self-discharge

• Balance autonomy against duty of care.
• Assess decision-making capacity.
• The medical and mental-health assessment is incomplete.
• Explore and address reasons for wanting to leave.
• Engage family and nursing support and offer acceptable options.
• Use involuntary intervention only when indicated and legally authorised.