Anorexic Ava — Anorexia Nervosa: Starvation, Bradycardia & Refeeding Syndrome
She is freezing in a warm room, her heart beats in the 40s — and the danger begins the moment she starts eating again
Ava is admitted with a heart rate of 42 and a temperature of 96.1. She insists she is fine. On day two of nutrition her phosphorus falls and the monitor starts to change.
Ava restricts her intake because of an intense fear of gaining weight and a distorted body image, even though her weight is dangerously low. Starvation slows the whole body: bradycardia, hypotension, hypothermia, amenorrhea, dry skin and fine lanugo hair. The exam's favorite twist is refeeding syndrome — when nutrition restarts, insulin rises and drives phosphorus, potassium and magnesium into the cells, dropping serum levels fast enough to cause dysrhythmias, heart failure and seizures. Calories are restarted slowly with daily electrolyte monitoring.
Read Anorexic Ava's full story →The story arc
The setup
Ava is admitted after fainting at school. She is wrapped in two blankets, wears baggy clothes, and tells the nurse she 'already ate.'
The turn
Her heart rate sits in the 40s, her blood pressure drops when she stands, and her potassium comes back low.
The crisis
Two days after nutrition is restarted, Ava becomes confused and weak, and her phosphorus, potassium and magnesium have all fallen.
The save
The team slows the calorie advance, replaces electrolytes, monitors her heart continuously, and a dietitian and therapist join her plan with supervised meals and bathroom monitoring.
NCLEX study section — Anorexia Nervosa: Starvation, Bradycardia & Refeeding Syndrome
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Mental Health
Take this chapter into practice questions on the same topic.