When Are Eating Disorders Treated in the ER?
Most patients with eating disorders are treated outpatient or in specialized programs (like IOP or residential). However, a trip to the emergency room may be necessary when there's a medical emergency or acute safety risk, including:
Medical Reasons for ED Admission:
Bradycardia (heart rate < 50 bpm resting, or < 40 during sleep)
Low blood pressure
Hypothermia
Severe electrolyte imbalances (especially low potassium or phosphorus)
Dehydration or acute malnutrition
Fainting or seizures
Refusal to eat or drink for days
Rapid weight loss or very low BMI (especially in children)
Acute gastrointestinal distress
Concerns for refeeding syndrome
Psychiatric Reasons for ED Admission:
Suicidal thoughts or self-harm
Severe anxiety, panic, or behavioral dysregulation
Refusal of care that endangers life
What Happens in the Emergency Department?
Here’s what typically happens when someone with a suspected eating disorder presents to the ED:
1. Initial Assessment
Vital signs: heart rate, BP, temperature, oxygen levels
Weight (sometimes cautiously, depending on age and protocol)
Mental status exam
2. Medical Workup
Blood work: CBC, electrolytes, liver function, thyroid panel
EKG to evaluate for heart arrhythmias or QT prolongation
Urinalysis for hydration status
Phosphorus (especially during refeeding)
Possibly pregnancy test in menstruating teens
May include imaging if GI symptoms or risk of aspiration/purging
3. Stabilization
If any critical values are found (e.g., low potassium, dangerously low HR), they may:
Administer IV fluids and/or electrolytes
Begin medical monitoring
Consult pediatrics, cardiology, or psychiatry
Admit the patient to inpatient medical or psychiatric unit, depending on severity
What Comes Next: Hospital Admission or Discharge?
Admission to Medical Unit
This happens when:
The patient is medically unstable
There’s concern for refeeding syndrome
Psychiatric issues can’t be addressed until medically cleared
Often includes:
Heart monitoring
Slow, monitored nutrition reintroduction (possibly NG tube feeding)
Coordination with eating disorder specialists
Psychiatric Admission
If there's acute suicidality or refusal of life-sustaining care, the patient may be admitted to a psychiatric hospital or ED-specific psych unit (if available).
Discharge to Outpatient/Follow-Up
If the patient is medically stable, they may be discharged with referrals:
Outpatient therapy, dietitian, or physician
IOP, PHP, or residential ED program
Tips for Families & Providers
Bring documentation if possible (recent vitals, labs, therapist notes) to help the ED team quickly understand the context.
If you’re already working with an ED provider, let the ED staff know — they may want to consult your outpatient team.
ED staff may not be ED specialists — so advocate kindly. You can say:
“We’re concerned about ARFID/anorexia, and we’ve been told to monitor for low heart rate/electrolyte issues. Can you please check labs and EKG?”
Have realistic expectations: Most EDs are designed for stabilization, not long-term ED care. Your best path forward is often prompt follow-up with a specialty clinic after the ER visit.
In Summary
Emergency departments treat eating disorders by:
Identifying and treating acute medical risks
Monitoring for life-threatening complications
Referring for higher levels of care
Stabilizing before transfer or discharge
They are a bridge — not a full solution. The goal is to keep patients safe and connected to the care they need for long-term healing.
Need help figuring out what level of care is appropriate for a teen or young adult?
We’re here to guide you — and your child — to the support they need.
