NUTRITION QUICK LESSON
Eating Disorders
Patho BN >1x/wk x >3mo
Nonpharm AN First line
Controlled wt gain: 0.9-1.4kg/wk inPT, 0.2-0.5kg outPT
Limited mild exercise (supervised graded), psych post body wt normalization, warming therapy
BN First line (along w pharm for best outcomes)
- May cause temp worsening w psych tx
Pharm AN
Prokinetics: domperidone (preferred, ↓ EPS), metoclopramide (if antinauseant effect needed) treat
gastroparesis to ↓ sensation of fullness (30min ac or domperidone hs)
- + erythro for intestinal mobility if ineffective
- Prucalopride for constipation and colonic fx
Taper lax if misuse
Zinc gluconate: ↑ wt gain rate x 2mo
- Cc (nausea), space from tetracyclines
2g APh: ↓ delusional thinking, anorexic rumination
- Olanzapine: for wt gain x 3mo or no longer needed to wt gain (BMI max 17)
- Quetiapine: for severe anx in ED (>BZD for anx) ac and hs
Cyproheptadine qhs: mod wt gain, hypnotic effects
BZD for severe anx
Thiamine (B1): beginning of feeding to prevent encephalopathy (WK)
SSRI (fluoxetine): co-existing depression, anx, purge disorders
- Used if co-exist psych, purge behavior or anx, AND stable cardiac status
*ondansetron not effective for N/V in eating disorder
BN
SSRIs: fluoxetine x 6mo-1y mtn once effective
- Tx w one AD only
Other: trazodone (useful in insomnia), venlafax
- Do NOT use bupropion, TCA, MAOIs
*purging can ↓drug absorption
Monitoring Contraception needed even if amenorrheic
Total Parenteral Nutrition
TPN IV (centrally or periph)
- Central: allows for high V/osmol to avoid vein irritation (D>10, prot >5%), long term >10-14d
- periph: osm <600-900
Peripheral TPN
Adv Easy to start, for short term (<1w), ↓ risk of complications (central-line assoc bloodstream infx)
Disad Q24h bag change, phlebitis, limits nutrition/lytes that can be given, risk of infx ↑ v central
v
Central TPN
Adv Can infuse >900 osm, can give more lytes (K >80)
Disadv Surgical/radiological procedure to place PICC, risk of infx during access
Types
2 in one Dextrose and AA are in 1 bag, lipids separate
3 in one Reqs compounding machine
↑ osm, may need to be given centrally
Adv: ↓ time, easy, ↓ contam, better fat utilization, cts fat infusion
Disadv: ↓ stability/compatibility, fat emulsion, limits amount of nutrients that can be compounded (or
Eating Disorders
Patho BN >1x/wk x >3mo
Nonpharm AN First line
Controlled wt gain: 0.9-1.4kg/wk inPT, 0.2-0.5kg outPT
Limited mild exercise (supervised graded), psych post body wt normalization, warming therapy
BN First line (along w pharm for best outcomes)
- May cause temp worsening w psych tx
Pharm AN
Prokinetics: domperidone (preferred, ↓ EPS), metoclopramide (if antinauseant effect needed) treat
gastroparesis to ↓ sensation of fullness (30min ac or domperidone hs)
- + erythro for intestinal mobility if ineffective
- Prucalopride for constipation and colonic fx
Taper lax if misuse
Zinc gluconate: ↑ wt gain rate x 2mo
- Cc (nausea), space from tetracyclines
2g APh: ↓ delusional thinking, anorexic rumination
- Olanzapine: for wt gain x 3mo or no longer needed to wt gain (BMI max 17)
- Quetiapine: for severe anx in ED (>BZD for anx) ac and hs
Cyproheptadine qhs: mod wt gain, hypnotic effects
BZD for severe anx
Thiamine (B1): beginning of feeding to prevent encephalopathy (WK)
SSRI (fluoxetine): co-existing depression, anx, purge disorders
- Used if co-exist psych, purge behavior or anx, AND stable cardiac status
*ondansetron not effective for N/V in eating disorder
BN
SSRIs: fluoxetine x 6mo-1y mtn once effective
- Tx w one AD only
Other: trazodone (useful in insomnia), venlafax
- Do NOT use bupropion, TCA, MAOIs
*purging can ↓drug absorption
Monitoring Contraception needed even if amenorrheic
Total Parenteral Nutrition
TPN IV (centrally or periph)
- Central: allows for high V/osmol to avoid vein irritation (D>10, prot >5%), long term >10-14d
- periph: osm <600-900
Peripheral TPN
Adv Easy to start, for short term (<1w), ↓ risk of complications (central-line assoc bloodstream infx)
Disad Q24h bag change, phlebitis, limits nutrition/lytes that can be given, risk of infx ↑ v central
v
Central TPN
Adv Can infuse >900 osm, can give more lytes (K >80)
Disadv Surgical/radiological procedure to place PICC, risk of infx during access
Types
2 in one Dextrose and AA are in 1 bag, lipids separate
3 in one Reqs compounding machine
↑ osm, may need to be given centrally
Adv: ↓ time, easy, ↓ contam, better fat utilization, cts fat infusion
Disadv: ↓ stability/compatibility, fat emulsion, limits amount of nutrients that can be compounded (or
