Table 2

Medical criteria suggesting need for hospitalisation of patients with anorexia nervosa from UK, France, Australia and New Zealand and the USA

UK (Marsipan, Royal Colleges of Psychiatrists/ Physicians/ Pathologists*)28France (Haute Autorité de Santé)91Australia and new Zealand (Royal Australian and New Zealand College of Psychiatrists)23USA (American Psychiatric Association)92
BMI (kg/m2)<13 (deemed high risk)<14<12(<85% ‘healthy’ body weight)
Weight lossloss of 20% body weight in 3 months1 kg/week over several weeks or grossly inadequate nutritional intake (<100 kcal daily) or continued weight loss despite community treatmentAcute weight decline with food refusal
HR (bpm)<40<40
Or HR >60 at rest if BMI <13
<40 or >120<40
Temp oC<35<35<35<36.1
BPLow<90/60 mm Hg<80 mm Hg SBP<90/60 mm Hg
Orthostatic changesPostural symptomspostural tachycardia or >20 mm Hg
Volume statusDehydrationDehydration
ECGQTc >450 ms, T-wave changes, hypokalaemia changesAny arrhythmia, prolonged QTc or non-specific ST/T changesCardiovascular organ compromise needing acute treatment
Blood glucose<3.0 mmol/LSymptomatic <3.3 mmol/L or asymptomatic <1.7 mmol/L<2.5 mmol/L<3.3 mmol/L
Potassium<3.0 mmol/L<3.0 mmol/L<3.0 mmol/L<3.0 mmol/L
Sodium<130 mmol/L<125 or >150 mmol/L<125 mmol/LElectrolyte imbalance
Liver transaminaseRaised transaminasesTen times normalAST or ALT>500Hepatic organ compromise needing acute treatment
White cells<1.0×109/L
MagnesiumBelow normalElectrolyte imbalance
Phosphate<0.5 mmol/LBelow normalElectrolyte imbalance
Renal functionRaised urea or creatinineCreatinine clearance <40 mL/mineGFR<60 mL/min (or 25% drop in a week)Renal organ compromise needing acute treatment
OtherSUSS score two or less (particularly if falling)Hypotonia/ muscle weakness, altered consciousness, intractable vomitingAlbumin <30 g/LPoorly controlled diabetes
  • *It should be noted that the UK do not define admission criteria as such, these are for consideration as ‘high risk’.

  • ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; BP, blood pressure; eGFR, estimated Glomerular Filtration Rate; HR, heart rate; SBP, systolic blood pressure; SUSS, Sit up-Squat Stand.