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Anorexia is not an uncommon primary presenting complaint. It is not uncommon for concerns to be raised regarding anorexia in ED for patients with other primary PCs – especially in mental health. Below is a framework for workup for these patients.

Step 1: Assess for Red Flags

BMI < 16
Syncope
Palpitations (hypoK, hypoCa, hypoMg)
Injuries sustained from falls
Significant weight change (despite normal weight on presentation)

Step 2: Focused Assessment

History
AMPLE – including social history. work. living situation.
Weight change
Exercise habits
Hair loss
Missed/Irregular periods

SCOFF Questionaire (Bulimia, Binging, Weight Loss, Body Dysmorphia, Food Focused)
– Do you ever make yourself sick (S) because you feel uncomfortably full?
– Do you worry you have lost control (C) over how much you eat?
– Have you recently lOst (O) more than 6kg in a three month period?
– Do you believe yourself to be fat (F) when others say you are too thin?
– Would you say that food (F) dominates your life?

Examination
Postural hypotension / tachycardia
BMI: weight/height
Lanugo
Thin hair

Brief Psych Evaluation / MSE
Appearance
Speech
Emotions (Mood/Affect)
Perception (hallucinations/delusions)
Thoughts (suicidality / guilt)
Insight
Cognition

Investigations
ECG VBG – glu, electrolytes.
U&E, CMP, LFT – hypoalbuminaemia.

Step 3: Ensure No Admission Criteria

BMI > 16.
No postural hypotension or tachycardia.
Biochemical parameters reasonable.
ECG WNL.
MSE no acute suicidality/self harm ideation.

Consider admission if meets criteria above^

Notes Template (written in the negative)

Weight:
Height:
BMI is > 16 (Measured ___)
Able to stand from sitting with arms crossed. Quads not wasted. Thin, but does not appear cachectic.
No postural hypotension or tachycardia.
- Lying/Supine sBP/dBP/MAP/HR:
- Standing sBP/dBP/MAP/HR:
Biochemical parameters: 
- rBGL > 3.5 (measured )
- Sodium > 130 and is within normal limits (measured)
- Magnesium > 0.7 (measured )
- Phosphate > 0.8 (measured )
- Albumin > 35 (measured )
- Liver enzymes (ALP / ALT / GGT) not elevated. (all measurements normal)
- Neutrophils > 2.0 (measured )
ECG NSR with no bradycardia / tachycardia / prolonged QT.