Physical risk guidance

(Priority should be given to the overall physical examination of the patient)

SystemExaminationModerate riskHigh risk
NutritionBMI<15<13
BMI centiles<3<2
Weight loss/wk>0.5 kg>1.0 kg
Purpuric rash+
CirculationSystolic BP<90 mm Hg<80 mm Hg
Diastolic BP<60 mm Hg<50 mm Hg
Postural drop>10 mm Hg>20 mm Hg
Pulse rate<50 BPM<40 BPM
ExtremitiesDark blue/cold
Musculo – skeletal (Squat Test*)Unable to get up without using arms for balance+
Unable to get up without using arms as leverage+
Unable to sit up without using arms as leverage+
Unable to sit up at all+
Temperature<35°C<34.5°C
InvestigationsFBC, urea, electrolytes (including PO4), LFT, Albumin, Creatinine kinase, GlucoseConcern if outside normal limitsK <2.5
Na <130
Po4<0.5
ECGRate <50Rate <40
Prolonged
QT interval
*

The squat test gives a clinical indication of muscle power and may be used to monitor progress. The patient lies flat on a firm surface such as the floor and has to sit up without, if possible, using her hands. This is more sensitive to myopathic weakness.

From: Appendix 7, Physical Risk Assessment

Cover of Eating Disorders
Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders.
NICE Clinical Guidelines, No. 9.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society (UK); 2004.
Copyright © 2004, The British Psychological Society & The Royal College of Psychiatrists.

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