Scribd
Upload
122 views1 page

MARSIPAN Checklist: For Really Sick Patients With Anorexia Nervosa

The document provides a checklist for assessing and managing really sick patients with anorexia nervosa. It includes factors to assess such as BMI, electrolyte levels, and vital signs. It also covers managing risks like refeeding syndrome and behaviors that could increase risks.

Uploaded by

Idara
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
122 views1 page

MARSIPAN Checklist: For Really Sick Patients With Anorexia Nervosa

The document provides a checklist for assessing and managing really sick patients with anorexia nervosa. It includes factors to assess such as BMI, electrolyte levels, and vital signs. It also covers managing risks like refeeding syndrome and behaviors that could increase risks.

Uploaded by

Idara
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

||MARSIPAN checklist

for Really Sick Patients with Anorexia Nervosa


Assessing Refeeding Managing
Does the patient have anorexia Is intensive medical care needed? Are medical and psychiatric staff
nervosa?  Yes collaborating in care?
 Yes  No and regular risk monitoring in place  Yes
 Not sure and psychiatric review requested  No and psychiatric consultation awaited
Increased risk of refeeding
Are there significant risk factors? syndrome?
 BMI <13 (adults) or <70% median BMI for age  Low initial electrolytes Are nurses trained in managing
(under 18)?
 Low BMI (<13 or mBMI <70%)
medical and psychiatric problems?
 Recent loss of ≥1 kg for two consecutive  Yes
 Significant comorbidities (e.g. infection,
weeks?  No and appropriately skilled staff
cardiac failure, alcoholism, uncontrolled
 Little or no nutrition for >5 days? diabetes) requested/training in place
 Acute food refusal or <500 kcal/day for >2 days ÎÎ Start at 5–10 kcal/kg/day
in under 18s?
ÎÎ Monitor electrolytes twice daily and build up Are there behaviours that increase
 Pulse <40? calories swiftly: avoid underfeeding risk?
 BP low with postural dizziness?
Lower risk of refeeding syndrome?  Purging behaviours
 Core temperature <35°C?
ÎÎ Start at 15–20 kcal/kg/day and build up  Falsifying weight
 Na <130 mmol/L?
swiftly  Disposing of feed
 K <3.0 mmol/L?
ÎÎ Avoid underfeeding syndrome  Exercising
 Raised transaminase?
Give all adults oral thiamine and  Self-harm, suicidality
 Glucose <3 mmol/L?
Pabrinex®  Family distress/anxiety
 Raised urea or creatinine?
 Safeguarding concerns
 ECG: e.g. bradycardia? QTc >450 ms? Monitor
ÎÎ Mobilise psychiatric team to advise on
Is the patient consenting to treatment? ÎÎ Electrolytes (especially P, K) management
 Yes ÎÎ ECG
 No and assessment for compulsory detention ÎÎ Vital signs
requested ÎÎ BMI

© 2015 The Royal College of Psychiatrists. To request permission for republication (in print, online or by any other medium), please write to permissions@[Link]
See full report: Royal College of Psychiatrists, Royal College of Pathologists, Royal College of Physicians. MARSIPAN: Management of Really Sick Patients with Anorexia Nervosa, 2nd edition (College Report CR189).
Royal College of Psychiatrists.

You might also like