Adherence to Dutch Guideline in Hospitalized Anorexia Nervosa Adolescents.

Background. The Dutch guideline Eating Disorders defines admission criteria for children with anorexia nervosa (AN) in need for medical stabilization and advices close monitoring to detect refeeding syndrome (RFS) in an early stage. Methods. Admission criteria, recommendations at admission, and during first week of hospitalization were evaluated in accordance to the guideline. RFS was defined as decreased electrolyte concentrations and/or clinical features. Results. 22 patients were included with a total of 50 admissions. We observed that 62% of the admitted patients met one of the admission criteria, 190/300 (63%) recommended admission examinations were performed. During admission adherence decreased, in particular daily weighing and physical examination (12% and 6%, respectively). The guideline was not fully followed in any of the patients. None of the hospitalized patients met the RFS criteria. Conclusion. Guideline adherence was moderate and can be improved by a few adaptations, which may limit unnecessary laboratory testing.

[Self-harm among children and adolescents]. / Zelfbeschadiging bij kinderen en adolescenten.

Self-harm among children and adolescents is a prevalent health issue. Definitions of self-harm differ, and the distinction between attempted suicide or self-harm is often unclear. A recent large population-based cohort study on self-harm among children and adolescents aged 10-29 years showed a sharp increase in the incidence of self-harm, especially in girls aged 13-16 years. It also showed an inequality in treatment offered, depending upon the socio-economic profile of the region in which the patient presented.We illustrate the problem of self-harm by presenting a clinical case, and provide advice on when to suspect self-harm and how to proceed when self-harm is suspected. Furthermore, we show that a similar increase in incidence of self-harm to that which has taken place in the UK has also been signaled in the Netherlands. Self-harm is associated with an increased risk of death by suicide and other causes of unnatural death. Evidence for therapeutic options for self-harm is limited.

Acute motor and sensory axonal neuropathy in LEOPARD syndrome.

A case of acute predominantly axonal motor and sensory neuropathy (AMSAN) is reported in a 16-year-old boy with LEOPARD syndrome (the acronym represents lentigines, ECG conduction abnormalities, ocular hypertelorism, pulmonic stenosis, abnormal genitalia, retardation of growth, and sensorineural deafness). The presentation was atypical for acute motor and sensory axonal neuropathy, in that this patient had progression of symptoms of more than 4 weeks and there were signs of reinnervation in the acute phase. Treatment response to intravenous immunoglobulins was excellent. In patients with LEOPARD syndrome and acute neuropathies, treatment with intravenous immunoglobulins should be considered.