Cardiovascular and Metabolic Assessment in Adolescents with Eating Disorders

Immediate Vital Signs and Physical Assessment

The American Academy of Pediatrics recommends obtaining orthostatic vital signs immediately, including temperature, resting heart rate, blood pressure, orthostatic pulse changes, and orthostatic blood pressure, as cardiovascular compromise can develop rapidly in malnourished adolescents 1, 2
Documenting current height, weight, and BMI percentile for age, comparing to previous growth charts, helps identify weight loss patterns and growth trajectory changes, as recommended by the American Academy of Pediatrics 1, 2
Examining for physical signs of malnutrition, including muscle wasting, lanugo hair, and signs of purging behaviors, is crucial in assessing the severity of the eating disorder 1, 2

The American Heart Association recommends ordering an electrocardiogram immediately to assess for QTc prolongation and arrhythmias, which are potentially fatal complications of eating disorders 1, 2
Obtaining a complete blood count to assess for anemia and leukopenia from malnutrition is essential, as recommended by the American Society of Hematology 1, 2
Ordering a comprehensive metabolic panel, including electrolytes, liver enzymes, and renal function tests, helps identify hypokalemia, hypochloremic alkalosis, and other electrolyte abnormalities that can cause respiratory symptoms and cardiac arrhythmias, as recommended by the National Institute of Diabetes and Digestive and Kidney Diseases 1, 2, 3

Quantifying specific eating and compensatory behaviors, including frequency and intensity of dietary restriction, binge eating episodes, self-induced vomiting, laxative use, diuretic use, and compulsive exercise patterns, is crucial in assessing the severity of the eating disorder, as recommended by the American Psychiatric Association 1, 2
Establishing a weight history, including maximum weight, minimum weight, recent weight changes, and timeline of weight loss, helps identify patterns of weight loss and growth trajectory changes, as recommended by the American Academy of Pediatrics 1, 2
Determining types and frequency of purging behaviors, including vomiting, laxatives, and starvation, is essential in assessing the risk of electrolyte abnormalities and cardiac complications, as recommended by the American Gastroenterological Association 4, 3

Screening for co-occurring psychiatric conditions, including depression, anxiety, obsessive-compulsive disorder, and suicidality, is crucial in identifying comorbidities that require concurrent treatment, as recommended by the American Psychiatric Association 1, 4, 3
Evaluating menstrual history, including amenorrhea, helps identify hypothalamic-pituitary-gonadal axis suppression from malnutrition, as recommended by the American College of Obstetricians and Gynecologists 4, 3

Considering exercise-induced bronchoconstriction as a potential cause of shortness of breath in adolescents with eating disorders is essential, as recommended by the American Academy of Allergy, Asthma, and Immunology 5
Evaluating for food-dependent exercise-induced anaphylaxis as a potential cause of shortness of breath in adolescents with eating disorders is crucial, as recommended by the American Academy of Allergy, Asthma, and Immunology 5

Assessing family dynamics and support systems, including parents' understanding of the illness and their approach to treatment, is essential in identifying potential barriers to treatment, as recommended by the American Academy of Pediatrics 4, 3
Determining the level of functioning at home, school, and with peers helps establish a baseline psychosocial impairment, as recommended by the American Psychiatric Association 1, 4, 3

Not assuming normal laboratory results exclude serious illness is crucial, as more than half of adolescents with eating disorders have normal test results despite being medically unstable, as recommended by the American Academy of Pediatrics 4, 3
Not delaying ECG while waiting for other test results is essential, as cardiac complications are the leading cause of death in eating disorders and require immediate identification, as recommended by the American Heart Association 1