Eating Disorders

An eating disorder can bring a psychiatric diagnosis into a medical emergency. Restriction, binge eating, compensatory behaviours, or avoidant eating can lead to bradycardia, hypotension, hypothermia, electrolyte disturbance, arrhythmia, neuromuscular weakness, and cognitive change. The patient may not appear critically ill, and a normal or higher body weight does not exclude serious physiologic compromise. The RN’s first clinical question is therefore not simply, Which eating disorder is this? It is, How much physiologic reserve does this patient have right now? Pair the behavioural history—what the patient eats, avoids, vomits, takes as a laxative or diuretic, exercises, or omits insulin—with vital signs, mental status, weight trajectory, ECG findings, and laboratory results. Treatment should be coordinated with the patient and support system in the least intensive environment that can safely provide it. When the heart, circulation, temperature, electrolytes, or mental status are unstable, medical stabilization takes priority over routine outpatient psychotherapy or negotiation about meals.