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Medical emergencies in eating disorders
  1. Holly Pennick1,
  2. Lesley Cousins2,
  3. Dilshad Marikar1
  1. 1 Paediatrics, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, Suffolk, UK
  2. 2 Child and Adolescent Eating Disorder Service, Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
  1. Correspondence to Dr Dilshad Marikar, Paediatrics, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, Suffolk IP33 2QZ, UK; dilshad.marikar{at}

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About the guideline

Eating disorders are serious mental health disorders that cannot be appropriately managed without both physical and mental healthcare. These illnesses, including anorexia nervosa, have the highest avoidable mortality rates of all mental health conditions. Paediatricians should be aware that the risk of death in children with eating disorders is comparable to that of asthma and diabetes.1

The COVID-19 pandemic and its aftermath have had a significant impact in terms of increased incidence as well as acuity of presentations of children with eating disorders, which has contributed to a 90% increase in hospital admissions in the last 5 years.2

All paediatricians will encounter children with eating disorders in the acute inpatient setting. We acknowledge the anxiety that may be generated when caring for these children.

Medical Emergencies in Eating Disorders (MEED): Guidance on Recognition and Management, was published by the Royal College of Psychiatry, and endorsed by the Academy of Medical Royal Colleges, in May 2022. It provides an important framework for caring for patients with eating disorder when they are most unwell. It is a joint guideline for adults, children and adolescents and succeeds the 2012 Junior MARSIPAN (Management of Really Sick Patients with Anorexia Nervosa) guidance, which most clinicians will have familiarity with.

The development of MEED arose from the recognition that medical care for eating disorders was still at times lacking, resulting in preventable deaths, despite admission to hospital.

MEED builds on the MARSIPAN guidance by providing:

  • An up-to-date traffic light risk assessment tool.

  • Summary sheets for target clinical groups (including paediatric physicians).

  • New advice around more higher calorie refeeding.

Key issues addressed in this guideline

Risk assessment

MEED presents a range of physical and psychological parameters that are rated on a traffic light system as red (high impending risk to life), amber (alert to high impending risk to life) or green (low …

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  • Twitter @MDMarikar

  • Contributors DM approached the journal for interest in the article. The first draft was written by HP with subsequent edits made by DM and LC. DM and LC provided additional insight for the commentary section.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.