Dehydration and the Treatment of Eating Disorders
Article Contributed By: Maria Wichman, R.N., Child/Adolescent Inpatient Eating Disorders Clinical Services Manager, Rogers Memorial Hospital & Lyn Marshall, MSN, Clinical Specialist and Director of Nursing at Rogers.
Eating disorders’ symptoms can affect the body in many ways. Disorders in which patients purge or starve themselves not only deprive the body of much needed food but rob it of water, resulting in dehydration. Considering that the body is about 60 percent water, prolonged dehydration can lead to electrolyte imbalances that affect the heart and other organs and the thinking patterns of eating disorder sufferers.
Dehydration can be very dangerous and can result in long-term harm related to electrolyte imbalances, such as low potassium, that impacts the heart muscle.
Patients with eating disorders are not admitted to a hospital unless their situation is very serious.
Health Dangers of Eating Disorders
According to the National Eating Disorder Association (NEDA), medical problems caused by various eating disorders can cause:
- Irregular heart rate and risk of heart failure
- Severe dehydration, resulting in kidney failure
- Muscle loss and weakness
- Peptic ulcers and pancreatitis
- Potential for gastric rupture during periods of bingeing
- High blood pressure
- High cholesterol levels
- Type II diabetes mellitus
- Gallbladder disease
Admitting Someone to Inpatient Treatment
When patients are admitted to an inpatient program, their eating disorder may include medical problems. We treat their medical symptoms by re-feeding and rehydrating them, sometimes through nasal gastric tube feeding.
Just as critical as nutrition is the work to uncover what is driving the eating disorder, such as body image issues, a history of trauma and abuse, or low self-esteem.
The Thinking Patterns of Eating Disorders
Each person is different, but there seems to be one common denominator: faulty thinking. Many patients see themselves as fat, whether or not the mirror tells a different story. In some people, the thoughts are ingrained more deeply than in others. Trust in the staff is important, and it takes time to build that trust.
I recall more than one patient, terrified that eating and drinking normally would make them overweight, say, “You are trying to make me fat!”
Challenging Those Thinking Patterns
I try to challenge that idea by saying, “Your dietitian, physician, nurse, and the whole treatment team believe you need to be re-nourished”. The message is, we will help you eat normally, but we are not going to make you fat. That usually makes the individual stop and think, but it’s only the first step in trust.
Our biggest challenge is when patients dig in their heels and refuse to eat. Others may try to disconnect their feeding tube.
Family Involvement Is Necessary
Because I work primarily with children and adolescents, family involvement is also critical. We want to make sure they, as well as the patient, learn about eating behaviors and how to manage them because they will be the day-to-day support system.
We have sessions during which the patient and loved ones eat meals with a staff member and go over questions such as, “What do we talk about at mealtime?” This helps promote honest, open communication among family members. The goal is to help patients and families develop effective skills to help them sustain recovery from eating disorders throughout their lives.
Proper Nutrition Helps the Thinking Mind
When patients do start to eat and drink and become better nourished, a lot of the faulty thinking diminishes. I’ve often seen proper nutrition help break the loop of unhealthy thoughts and make patients more receptive to new ways of thinking. Using techniques that work with obsessive compulsive disorder (OCD) also can be very helpful because there often is an element of OCD with eating disorders.
Treatment does not end after a two-week hospitalization, however, because we want patients to gradually become used to less restrictive environments and more responsibility. That’s why Rogers Memorial offers residential and partial programs to continue to prepare for life at home.
As a clinician working with children and adolescents, I’ve found that to be effective you need compassion and more. You need to be empathetic, patient, a good listener and enjoy building relationships. And you need to always be willing to learn more to do the job to the best of your ability.