What is the treatment for anorexia nervosa in patients with a weight less than 75% of their ideal body weight or with electrolyte imbalances?

In cases of anorexia nervosa where patients weigh less than 75% of their ideal body weight or present with electrolyte imbalances, hospitalization and pharmacotherapy become critical components of treatment. The severe malnutrition associated with a body weight this low presents serious health risks, including potential cardiac arrhythmias, electrolyte disturbances, and other medical complications that necessitate close monitoring and intervention.

Hospitalization not only allows for safe supervision of the patient's nutritional needs but also enables healthcare providers to stabilize any acute medical issues, particularly electrolyte imbalances. The inpatient setting is crucial for providing intensive management, which may include enteral feeding if oral intake cannot be adequately maintained.

In addition to addressing the physical aspects of the disorder, pharmacotherapy can be employed to manage co-occurring psychiatric conditions or to support the overall treatment plan. Antidepressants may be indicated if the patient also exhibits symptoms of depression or anxiety, both of which are common comorbidities in patients with anorexia.

While psychotherapy, such as cognitive-behavioral therapy, and supervised meals may be beneficial as part of a comprehensive treatment plan, they are generally more appropriate in outpatient settings where the patient is stable—meaning these approaches are not the primary intervention in the face of such acute medical fragility