Ratification Date: 07/07/2025

Next Review Date: 07/07/2026

Eating Disorders Care Pathway – under 18 yrs (Norfolk and Waveney)

 

Junior MARSIPAN and MEED guidance:

Junior Marsipan guidance has been superseded by the new MEED guidance. Available to study here: Medical emergencies in eating disorders (MEED) – Guidance on recognition and management – CR233

 

** CAEDS risk factors checklist:

  • Emaciation / wasting
  • BMI: less than 70% median BMI (approximately less than 0.4th BMI centile)
  • Acute food refusal: for more than 2 days or estimated calorie intake 400-600kcal per day
  • Pulse: 40bpm or less
  • Blood pressure: low or orthostatic changes as per pathway
  • Na: <130mmol/L
  • K: <3mmol/L
  • Glucose: <4mmol/L
  • Phosphate: below normal range for age, see current range from biochemistry
  • White cell count: low
  • Albumin: <35g/L
  • Temperature: <35°C
  • Peripheral cyanosis
  • Other biochemical abnormalities
  • ECG: bradycardia / tachycardia; QTC >460ms in females; QTC >450ms in males
  • Engagement with management plan: severe agitation / aggression when parents try to encourage food or fluid intake of limit compensatory behaviours; poor insight / motivation to engage with nutritional plan
  • Self harm / suicide: ideation with moderate to high risk of deliberate self-harm / suicide
  • Complex co-morbidity: severe obsessive compulsive disorder (OCD); major depressive disorder (MDD), severe emotional dysregulation; anxiety disorder; psychosis