When the outpatient treatment of adolescents with eating disorders fails, it often becomes necessary to hospitalize these patients. There are 12 factors that justify inpatient treatment of an adolescent with an eating disorder, according to the Society for Adolescent medicine. The criteria are in agreement with the recent revision of the American Psychiatric Association practice guidelines for the treatment of patients with eating disorders, the recently published American Academy of Pediatrics policy statement on identifying and treating eating disorders, and the American Dietetic Association position on nutrition intervention in the treatment of eating disorders.

One or more of the following criteria justify hospitalization:

1. Severe malnutrition (weight equal to or less than 75% average body weight for age, sex, and height)


2. Dehydration


3. Electrolyte disturbances (hypokalemia, hyponatremia, hypophosphatemia)


4. Cardiac dysrhythmia


5. Physiological instability
   
   
   
   • Severe bradycardia (heart rate less than 50 beats per minute daytime; less than 45 beats per minute at night)
   
   
   • Hypotension (less than 80/50 mm Hg)
   
   
   • Hypothermia (body temperature less than 96° F)
   
   
   • Orthostatic changes in pulse (greater than 20 beats per minute) or blood pressure (greater than 10 mm Hg)
   
   
   
   


6. Arrested growth and development


7. Failure of outpatient treatment


8. Acute food refusal


9. Uncontrollable binging and purging


10. Acute medical complications of malnutrition (eg, syncope, seizures, cardiac failure, pancreatitis, etc.)


11. Acute psychiatric emergencies (eg, suicidal ideation, acute psychosis)


12. Comorbid diagnosis that interferes with the treatment of the eating disorder (eg, severe depression, obsessive compulsive disorder, severe family dysfunction)

Source: The Society for Adolescent Medicine’s position paper “Eating Disorders in Adolescents” (J Adolescent Health 2003;33:496–503)