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*)28 | France (Haute Autorité de Santé)91 | Australia and new Zealand (Royal Australian and New Zealand College of Psychiatrists)23 | USA (American Psychiatric Association)92 | |
| BMI (kg/m2) | <13 (deemed high risk) | <14 | <12 | (<85% ‘healthy’ body weight) |
| Weight loss | – | loss of 20% body weight in 3 months | 1 kg/week over several weeks or grossly inadequate nutritional intake (<100 kcal daily) or continued weight loss despite community treatment | Acute 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 |
| BP | Low | <90/60 mm Hg | <80 mm Hg SBP | <90/60 mm Hg |
| Orthostatic changes | Postural symptoms | postural tachycardia or >20 mm Hg | – | |
| Volume status | – | Dehydration | – | Dehydration |
| ECG | QTc >450 ms, T-wave changes, hypokalaemia changes | – | Any arrhythmia, prolonged QTc or non-specific ST/T changes | Cardiovascular organ compromise needing acute treatment |
| Blood glucose | <3.0 mmol/L | Symptomatic <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/L | Electrolyte imbalance |
| Liver transaminase | Raised transaminases | Ten times normal | AST or ALT>500 | Hepatic organ compromise needing acute treatment |
| White cells | – | <1.0×109/L | – | – |
| Neutrophils | – | <0.5×109/L | <1.0×109/L | – |
| Magnesium | – | – | Below normal | Electrolyte imbalance |
| Phosphate | – | <0.5 mmol/L | Below normal | Electrolyte imbalance |
| Renal function | Raised urea or creatinine | Creatinine clearance <40 mL/min | eGFR<60 mL/min (or 25% drop in a week) | Renal organ compromise needing acute treatment |
| Other | SUSS score two or less (particularly if falling) | Hypotonia/ muscle weakness, altered consciousness, intractable vomiting | Albumin <30 g/L | Poorly 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.