Treatment Plan for Anorexia Nervosa Patient with Recent CVA and Rapid Weight Loss
The treatment plan for an anorexia nervosa patient with a recent small CVA in the high left frontal lobe from PFO who has lost 7 pounds in 15 days should prioritize immediate nutritional rehabilitation with careful refeeding to prevent refeeding syndrome, while also addressing the stroke with antiplatelet therapy.
Medical Stabilization and Nutritional Rehabilitation
Immediate Nutritional Intervention
- Start low-calorie refeeding at 5-10 kcal/kg/day with gradual increase over 4-7 days until reaching full nutritional requirements 1
- Enteral nutrition is preferred over parenteral when possible
- Monitor food intake for all people with malnutrition 1
- For patients with severe malnutrition (BMI <16 kg/m² or >15% weight loss in 3-6 months), the risk of refeeding syndrome is high 1
Electrolyte Supplementation (Critical)
- Before initiating nutrition therapy, administer thiamine 300 mg IV, followed by 200-300 mg IV daily for at least 3 more days 1
- Provide prophylactic electrolyte supplementation:
- Phosphate: 0.3-0.6 mmol/kg/day
- Potassium: 2-4 mmol/kg/day
- Magnesium: 0.2 mmol/kg/day IV or 0.4 mmol/kg/day orally 1
- Water-soluble and fat-soluble vitamins should be administered daily from the beginning of nutritional support 1
Monitoring During Refeeding
- Monitor electrolytes daily for the first 72 hours (highest risk period for refeeding syndrome) 1
- Assess for signs of fluid overload, respiratory distress, cardiac abnormalities, and night sweats 1
- Weigh patient regularly and record weight changes 1
Stroke Management
Antiplatelet Therapy
- For patients with an ischemic stroke or TIA and a PFO, antiplatelet therapy is reasonable 2
- This is the recommended first-line treatment for secondary stroke prevention in patients with PFO 2
PFO Management
- There are insufficient data to make a definitive recommendation regarding PFO closure in patients with first stroke and PFO 2
- PFO closure may be considered for patients with recurrent cryptogenic stroke despite medical therapy 2
- For high-risk patients with other indications for oral anticoagulation (such as hypercoagulable states), warfarin is reasonable 2
Psychiatric Management
Psychological Support
- Individual and family therapy are crucial to the long-term prognosis, especially when working with younger patients 2
- Evaluate for comorbid psychiatric diagnoses such as depression, anxiety, or obsessive-compulsive disorder 2
- Assess for history of physical or sexual abuse, violence, and suicidal ideation 2
Goal Setting
- Treatment should be individualized with goal weights based on age, height, stage of puberty, premorbid weight, and previous growth charts 2
- For a growing child or adolescent, goal weight should be reevaluated at three- to six-month intervals 2
Common Pitfalls to Avoid
- Too rapid advancement of nutrition during the first 3 days significantly increases the risk of refeeding syndrome 1
- Inadequate monitoring of electrolytes during the first 72 hours can miss early signs of refeeding syndrome 1
- Overlooking the psychological aspects of anorexia treatment while focusing solely on medical complications
- Failing to involve family members in the treatment plan, especially for younger patients
- Not addressing both the anorexia and stroke simultaneously - both conditions require immediate attention
Long-term Follow-up
- Continue nutritional support after hospital discharge 1
- Implement multidisciplinary nutritional support teams 1
- Reassess nutritional status every 3 months for stable patients 1
- Regular follow-up for stroke prevention and monitoring for recurrent cerebrovascular events
This treatment plan addresses both the immediate medical risks from anorexia nervosa with rapid weight loss and the recent cerebrovascular accident, prioritizing patient survival while setting the foundation for long-term recovery.