Eating Disorder Service
Creating Hope Together

Healthcare Professional's Area

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Other Investigations

ECG

ECG is advised if BMI less than 15, or if on medications that prolong QT interval.

Bradycardia is the most common finding in low weight patients, a resting heart rate can sometimes fall to around 40bpm. 

Prolonged QT interval, arrythmias and heart blocks are sometimes found. Any cardiac abnormalities should be considered serious and should be managed urgently according to clinical need.

An ECG is also advised in patients with severe electrolyte imbalance and those who use ipecac to induce vomiting, as this may cause cardiomyopathy. 

Dexa Bone Scan

Patients with anorexia nervosa are prone to early onset osteopenia and osteoporosis.  It is worth requesting a bone scan to check bone density.  We use this as a baseline, and also as a motivation tool, however unfortunately there is little evidence that an abnormal result increases motivation.

Scans are normally preformed every two years.

There is very little evidence for drug treatment of low bone mass in anorexia. The strongest evidence for increasing bone mass is treatment of the underlying anorexia, and restoration of weight with subsequent return of menses. If dietary calcium intake is low, then we do suggest a Calcium and Vitamin D supplement (eg Calcichew D3 Forte two tablets daily).  There is evidence that this can stop further deterioration, but it will not help with the increase in bone density.

The reason that oestrogen or bisphosphonates don't work very well is probably because anorexia bone disease is a combination of high bone resorption (due to low oestrogen and poor nutrition), but also low bone formation (due to low IGF-1 and high cortisol). There is also evidence that gut and adipocyte hormones act on bone, and these are dysregulated too in anorexia.  As well as the poor evidence for bisphosphonates, they are teratogenic and stay in the system for many years, so are not advised for our younger patients.