Life-Threatening Complications of Eating Disorders

Dear Colleagues,

Eating disorders are common serious conditions that may present to any clinician. The general practitioner may be faced with a patient with vague symptoms, and if weight and height are not measured, and eating disorders thought about, the diagnosis may be missed and the patient may rapidly deteriorate and present to the Emergency Department. There, bloods and an ECG may be taken, but if a nutritional assessment is not done and the patient is discharged, they may be brought back near death. If the patient is admitted, a physician or pediatrician will be faced with a patient who may be very severely malnourished, but resist attempts to improve nutritional state. The clinical problem may be seen as primarily physical, with the intention to involve mental health services when the patient is medically better. However, that is a mistake, because close joint medical/pediatric and psychiatric collaboration to manage the physical and psychological aspects of care in parallel is most likely to be successful. The patient may require expert nursing, both physical and mental, and careful refeeding with the help of a knowledgeable dietitian. Malnutrition and bulimic symptoms can lead to severe electrolyte imbalance and renal impairment. Additionally, if the patient has type 1 diabetes mellitus, the eating disorder can make the T1DM very hard to manage, and this alongside diabetic  complications can result in a seriously life-threatening clinical presentation.

In this Issue, we wish to cover the management of patients with eating disorders who present in a life-threatening clinical state. In addition to the scenarios described above, the patient may also suffer from depression and suicidal ideation. These complex presentations require detailed collaboration between psychiatric and medical professionals at all stages, and we hope that the Issue will serve as a guide to management.

Dr. Paul H. Robinson
Guest Editor

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