RCPSYCH Medical Emergencies in Eating Disorders: Guidance on Recognition and Management

The aim of this guidance is to make preventable deaths due to eating disorders a thing of the past. It is not a comprehensive textbook on eating disorders; rather, it addresses eating disorder presentations likely to lead the patient to an emergency department or a medical/paediatric ward. The emphasis is on medical management, meaning both physical and psychiatric care. The working group that produced this guidance is the fourth group to address these issues, which succeeds the Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN) and Junior MARSIPAN guidance.

The guideline includes:
• review and synthesise of the evidence on which the guidance is based, including a comparison with international guidance on medical management in eating disorders
• advice on the assessment and management of all eating disorders that can lead patients to present as a clinical emergency
• eating disorders risk assessment tool using the ‘traffic light’ approach that can be applied to all ages
• a series of summary sheets (Annexe 1) written for the different target clinical groups (including physicians, psychiatrists, dietitians, GPs and nurses, as well as people with eating disorders, families and managers). These are intended to be quick reference guides that also signpost to key areas in the main guidance
• updated practice guidance on the physical, nutritional and psychiatric management of patients with severe eating disorders in medical units, including the appropriate use of mental health legislation
• advice for commissioners on required services for this group of very ill patients