Ratification Date: 04/03/2024
Next Review Date: 30/04/2025
Eating Disorders Care Pathway – under 18 yrs (Norfolk and Waveney)
Junior MARSIPAN
The summary version of the Junior MARSIPAN: Management of Really Sick Patients under 18 with Anorexia Nervosa can be accessed using the following URL:
*Junior MARSIPAN Red alert: Refer any young person with one or more Red alert criteria to Paediatric CAU / AMU / Gastroenterology at the Norfolk and Norwich University Hospital (NNUH) with simultaneous referral to CEN-CAEDS to facilitate early assessment of eating difficulties which may commence during acute stabilisation admission at the NNUH.
Low threshold for medical stabilisation for Amber alerts.
** CAEDS risk factors checklist:
- Emaciation / wasting
- BMI: less than 70% median BMI (approximately less than 0.4th BMI centile)
- Acute food refusal: for more than 2 days or estimated calorie intake 400-600kcal per day
- Pulse: 40bpm or less
- Blood pressure: low or orthostatic changes as per pathway
- Na: <130mmol/L
- K: <3mmol/L
- Glucose: <4mmol/L
- Phosphate: below normal range for age, see current range from biochemistry
- White cell count: low
- Albumin: <35g/L
- Temperature: <35°C
- Peripheral cyanosis
- Other biochemical abnormalities
- ECG: bradycardia / tachycardia; QTC >460ms in females; QTC >450ms in males
- Engagement with management plan: severe agitation / aggression when parents try to encourage food or fluid intake of limit compensatory behaviours; poor insight / motivation to engage with nutritional plan
- Self harm / suicide: ideation with moderate to high risk of deliberate self-harm / suicide
- Complex co-morbidity: severe obsessive compulsive disorder (OCD); major depressive disorder (MDD), severe emotional dysregulation; anxiety disorder; psychosis