Physical risk guidance

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

SystemExaminationModerate riskHigh risk
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+
InvestigationsFBC, urea, electrolytes (including PO4), LFT, Albumin, Creatinine kinase, GlucoseConcern if outside normal limitsK <2.5
Na <130
ECGRate <50Rate <40
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.

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Enquiries in this regard should be directed to the British Psychological Society.

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.