What are the criteria for hospital admission for patients with eating disorders?

Hospital Admission Criteria for Eating Disorders

Hospital admission for eating disorders should be based on medical instability, psychiatric risk, and failure of outpatient treatment, with priority given to patients showing vital sign abnormalities, severe malnutrition, or acute medical complications. 1

Medical Criteria for Hospital Admission

• Heart rate <50 beats per minute during daytime or <45 beats per minute at night requires immediate hospitalization due to risk of cardiac complications 1, 2
• Orthostatic hypotension (blood pressure drop >20 mmHg systolic or >10 mmHg diastolic) or orthostatic tachycardia (pulse increase >20 beats per minute) indicates significant cardiovascular compromise requiring inpatient care 1, 3
• Temperature <36.0°C (96.8°F) suggests hypothermia from malnutrition requiring medical stabilization 1
• Severe electrolyte disturbances, particularly hypokalemia (<3.2 mEq/L) from purging behaviors, which can lead to fatal cardiac arrhythmias 4, 5
• Blood glucose <60 mg/dL indicating hypoglycemia that requires immediate medical intervention 5
• QTc prolongation on ECG, particularly in patients with severe purging behaviors or restrictive eating disorders 1, 5

Nutritional and Weight-Based Criteria

• Weight <75% of ideal body weight or BMI <16 kg/m² in adults indicates severe malnutrition requiring nutritional rehabilitation 1
• Rapid weight loss (>1 kg or 2 pounds per week) even if current weight is not extremely low 1, 3
• Failure to maintain minimal nutritional intake in outpatient setting despite appropriate interventions 1, 3
• Signs of refeeding syndrome risk, including severely low phosphorus, potassium, or magnesium levels 5

Psychiatric and Behavioral Criteria

• Active suicidal ideation or plan, particularly common in patients with eating disorders who have a mortality rate nearly 6 times higher than age-matched controls 3
• Severe comorbid psychiatric conditions (severe depression, anxiety, obsessive-compulsive disorder) that impair ability to participate in outpatient treatment 1, 3
• Inability to control compulsive exercising or purging behaviors despite outpatient interventions 2
• Family environment that cannot support recovery or where there is significant conflict about treatment approach 1

Special Considerations for Children and Adolescents

• More aggressive criteria for hospitalization should be applied to children and adolescents, with hospitalization considered at higher weight percentiles than adults 1
• Children and adolescents have the best prognosis when eating disorders are treated rapidly and aggressively with hospitalization 1
• Family-based treatment should be incorporated into the treatment plan for adolescents and emerging adults with involved caregivers 1, 2

Medical Complications Requiring Immediate Hospitalization

• Acute gastric dilatation or gastric perforation from binge eating episodes 4
• Severe metabolic alkalosis from purging behaviors 5
• Syncope or presyncope episodes suggesting cardiovascular compromise 3
• Severe dehydration from purging or fluid restriction 4, 5

Treatment Approach During Hospitalization

• Individualized goals should be set for weekly weight gain and target weight for patients requiring nutritional rehabilitation 1
• Slow refeeding with possible phosphorus supplementation to prevent refeeding syndrome in severely malnourished patients 1, 5
• Multidisciplinary team approach incorporating medical, psychiatric, psychological, and nutritional expertise 1
• Transition planning to appropriate level of care after medical stabilization is achieved 6

Hospital admission decisions should be made based on the severity of medical and psychiatric symptoms, with the understanding that early intervention with appropriate level of care significantly improves outcomes and reduces mortality in eating disorder patients 3, 6.