Treasure reported criteria for evaluating a hospitalized patient with anorexia nervosa. Several of the parameters overlap with PREDIX.
Patient selection: hospitalized patient with anorexia nervosa.
Parameters:
(1) body mass index (BMI) in kg per sq m)
(2) rate of weight loss in kg per week
(3) skin breakdown
(4) purpuric rash
(5) systolic blood pressure in mm Hg
(6) diastolic blood pressure in mm Hg
(7) postural drop in systolic pressure in mm Hg (from sitting to standing)
(8) pulse rate in beats per minute
(9) squat test and sit up test
(10) temperature in °C
(11) white blood cell count in 10^9/L
(12) absolute neutrophil count in 10^9/L
(13) hemoglobin in g/dL
(14) acute hemoglobin drop
(15) platelet count in 10^9/L
(16) serum potassium in mmol/L
(17) serum sodium in mmol/L
(18) serum magnesium in mmol/L
(19) serum phosphate in mmol/L
(20) blood urea in mmol/L
(21) serum total bilirubin in µmol/L
(22) serum alkaline phosphatase
(23) serum AST in IU/L
(24) serum ALT in IU/L
(25) serum GGT in IU/L
(26) serum albumin in g/L
(27) serum creatinine kinase in IU/L
(28) blood glucose in mmol/L
(29) QTc interval in milliseconds
(30) cardiac arrhythmia
|
Parameter |
Concern |
Alert |
|
BMI |
12 to 13.9 |
< 12 |
|
rate of weight loss |
0.51 to 1 kg/wk |
> 1 kg/wk |
|
skin breakdown |
1-2 mm |
> 2 mm |
|
purpuric rash |
NA |
yes |
|
systolic blood pressure |
80 to 89 |
< 80 |
|
diastolic blood pressure |
60 to 69 |
< 60 |
|
postural drop in blood pressure |
11 to 20 |
> 20 |
|
pulse rate |
40 to 49 |
< 40 |
|
squat test |
unable to get up without using arms for balance |
unable to get up without using arms for leverage |
|
site test |
unable to sit up without using arms for leverage |
unable to sit up at all |
|
temperature |
34.5 to 34.9°C |
< 34.5°C |
|
WBC count |
2 to 3.9 |
< 2 |
|
absolute neutrophil count |
1 to 1.4 |
< 1 |
|
hemoglobin |
9 to 10.9 |
< 9 |
|
acute drop in hemoglobin |
NA |
yes |
|
platelet count |
110 to 129 |
< 110 |
|
serum potassium |
3.0 to 3.4 |
< 3.0 |
|
serum sodium |
130 to 134 |
< 130 |
|
serum magnesium |
0.5 to 0.7 |
< 0.5 |
|
serum phosphate |
0.5 to 0.8 |
< 0.5 |
|
blood urea |
7.1 to 10 |
> 10 |
|
total bilirubin |
20.1 to 40 |
> 40 |
|
serum alkaline phosphatase |
111 to 200 |
> 200 |
|
serum AST |
41 to 80 |
> 80 |
|
serum ALT |
46 to 90 |
> 90 |
|
serum GGT |
46 to 90 |
> 90 |
|
serum albumin |
32 to 34 |
< 32 |
|
serum CK |
171 to 250 |
> 250 |
|
blood glucose |
2.5 to 3.4 |
< 2.5 |
|
QTc interval |
NA |
> 450 ms |
|
cardiac arrhythmias |
NA |
Yes |
total number of concern findings =
= SUM(number of concern findings)
total number of alert findings =
= SUM(number of alert findings)
Interpretation:
• minimum number of concern findings: 0
• maximum number of concern findings: 30
• minimum number of alert findings: 0
• maximum number of alert findings: 30
Additional tests to consider
(1) thyroid function tests
(2) erythrocyte sedimentation rate
Specialty: Psychiatry
