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Junior Marsipan guidance has been superseded by the new MEED guidance.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