constipation in anorexia nervosa

[The Pride]

Hey guys,

I'm on call tonite, and just got called for an anorexic pt with 8 days w/o BMs. Did a PubMed search and nothing much came up. What I did was gave her a one time dose of Colace (to give her something, but not worry about giving her a chance to purge via laxatives) and instructed the nurses to push oral fluids. Her abdomen exam is benign. Anyone around with particular insight into this? I know anorexic pts do frequently have constipation- are there any particular regimens that work well in this population?

Thanks,
The Pride

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[Anasazi23]

I've come across this a couple times also.

It seems that often, an anorexic will start to eat while in the hospital, but if the patient has been in particular crisis with food restriction for a number of days, the extended bowel rest will make for some wicked constipation. IV fluids help, just monitor the lytes and give the normal treatments. Check for bowel sounds periodically if you're really concerned.

I hadn't had any complications with this...can always get a KUB and see if the bowel is packed with stool....

 

[pingouin]

I work on a floor for medically-admitted eating disordered patients. The doc I work under favors Miralax in these scenarios.

Reglan works well for the feelings of fullness if you're doing a refeeding and increasing the PO intake, but have to be careful of the EPS. She usually gives Benadryl to counter that if it's mild, or will just d/c the Reglan.

Also see a lot of induced diabetes insipidus by way of excessive urine output due to all the fluids going in and the loss of kidney function due to the ED. That's usually resolved around the time they're ready to be d/ced, or just after they leave.

Typically the refeeding is started at around 600 kcal/day, and brought up by 100-200 kcal/day until target is reached as determined by the dietitian. Labs daily for at least the first week, then e/o day, with careful attention to Mg, K, phos, BUN... and oral fluids aren't initially given on intake. After a few days, the pts are started on 1-2 cups/day, increased by 1-2 cups/day until they get to 10-12. A 1 L bolus is given if I/Os are unstable.

Our avg length of stay- 2 wks.

 

[MBK2003]

I worked 4 months on an inpatient eating disorder unit (yes, we actually had someone come in at 51% ideal body weight) where we encountered constipation on a DAILY basis. Rules of thumb, pts will abuse cathartic laxatives and there's no evidence they are needed. The recommendations of the eating disorder attendings and the GI attending who consulted on the rare "it's be 14 days and nothing is moving" is stick with Colace 100mg TID, double portions of water, and metamucil in 16 oz water BID, everything will eventually move. The one patient who developed an intusseption had a non-benign abdomen and was clearly "more than just constipation."

MBK2003