Child and Adolescent Psychiatry Consulting

Consider evaluating an individual for an ED who presents with any of the following:

• Precipitous weight loss/gain
• Weight loss or failure to gain expected weight/height in a child and adolescent who is still growing and developing
• Substantial weight fluctuations
• Electrolyte abnormalities (with or without ECG changes), especially hypokalemia, hypochloremia, or elevated CO2. High normal CO2 in the presence of low normal chloride and/or urine pH of 8.0 – 8.5 can indicate recurrent vomiting. Hypoglycemia may accompany such electrolyte changes.
• Bradycardia
• Amenorrhea or menstrual irregularities
• Unexplained infertility
• Excessive exercise or involvement in extreme physical training
• Constipation in the setting of other inappropriate dieting and/or weight loss promoting behaviors
• Type 1 diabetes mellitus and unexplained weight loss and/or poor metabolic control or diabetic ketoacidosis (DKA). These patients are at increased risk of developing sub-threshold and full syndrome EDs. Intentionally changing insulin doses (under-dosing or omission) will lead to weight loss, poor glycemic control (higher hemoglobin A1c), hypoglycemia/hyperglycemia, DKA, and acceleration of diabetic complications.
• A history of using one or more compensatory behaviors to influence weight after eating or perceived overeating or binge eating, such as self-induced vomiting, dieting, fasting or excessive exercise
• A history of using/abusing appetite suppressants, excessive caffeine, diuretics, laxatives, enemas, ipecac, excessive hot or cold fluids, artificial sweeteners, sugar-free gum, prescription medications (i.e., insulin, thyroid medications), psychostimulants, street drugs, or a variety of complementary and alternative supplements.