• Anorexia
• "Strict, psychologically driven weight loss attained by restricting food intake and possibly augmented by exercise & purging"
• BMI <17.5 or 15% below expected body weight
• 0.3-1% prevalence, 10% males
• Associated with depression 60%, anxiety 60%, OCD 60%
• Anaesthetic Mx
• History: include laxative abuse, drugs, alcohol
  Collateral history helpful
• Ix: FBC, U&E, LFT, Glucose, Mg²⁺, Ca²⁺, PO⁴⁻, urine dipstick, ECG, Echo
• Consider RSI, care with positioning, warming, temperature, measure temp, beware of pharmacological alterations
• Systemic effects
• CVS
• Low BP, ST depression, Long QT (antipsychotics, hypocalcaemia), TWI, SVT, VT, sinus arrest, LV impairment due to low muscle mass. Intra-op incidence 16-62%.
• Resp
• Metabolic alkalosis due to vomiting can cause bradypnoea; low pulmonary compliance.
• Renal
• Proteinuria, ↓GFR, ↓Na⁺/K⁺/Cl⁻/Ca²⁺/PO⁴⁻, renal calculi
• GI
• Enlarged salivary glands, periodontitis, Mallory-Weiss tear, oesophagitis, gastritis, fatty liver, cirrhosis, refeeding syndrome
• MS
• Myopathy, rhabdo, osteopenia, stress fractures, osteoporosis.
• Derm
• Lanugo hair, Russell's sign, poor wound healing
• Endo
• ↓FSH, LH, GnRH, Glucose, insulin, T3/4, High cortisol, GH
• Haem
• ↓platelets, haemolytic anaemia, leukopenia, bone marrow hypoplasia
• Neuro
• ↓cognitive function, grey/white matter changes, seizures, neuropathy, inc pain threshold
• CEACCP
  Link:ceaccp.oxfordjournals.org/content/9/2/61.full.pdf