Synopsis
Apply the all-age MEED framework to identify impending risk to life, choose an appropriate admission setting, and avoid false reassurance from weight, appearance or isolated normal tests.
- MEED is an all-age traffic-light aid, not a score that replaces judgement; one red or two amber ratings should probably be treated as high risk and prompts review of the detailed management table.
- High-risk weight ranges include adult BMI below 13 and under-18 median BMI below 70%, but NICE explicitly says not to use an absolute BMI or weight threshold alone to decide admission.
- A recent loss of at least 1 kg/week for 2 consecutive weeks in an undernourished person is red in MEED, and rapid loss at any weight can be dangerous.
- Assess pulse, lying and standing blood pressure, temperature, hydration, muscle function, ECG, glucose, sodium, potassium, bicarbonate, renal function, phosphate, magnesium, calcium, liver tests and blood count according to acuity.
- Children need age- and sex-adjusted observations and growth measures; adult cut-offs must not be copied directly into paediatric decisions.
- Medical admission is for active physical stabilisation and initiation of safe refeeding; specialist eating-disorder units require the capability to manage the identified medical risks or rapid transfer arrangements.
- Psychiatric danger, treatment resistance and carer capacity belong in the same formulation as physiology, but a mental-health assessment must not delay emergency medical care.
- Every transfer needs named medical, psychiatric, dietetic and nursing responsibilities, a feeding and monitoring plan, and escalation instructions that travel with the patient.
Key red flags
MEED classifies an awake heart rate below 40 beats/minute as red; tachycardia or an inappropriately normal pulse in severe undernutrition can also signal hypovolaemia or infection.
For adults, standing systolic pressure below 90 mmHg with recurrent syncope and a systolic fall over 20 mmHg or heart-rate rise over 30 beats/minute is a red pattern, not a single-number rule.
Tympanic temperature below 35.5°C, severe dehydration, inability to sit up or rise from a squat, prolonged QTc or another significant ECG abnormality requires urgent escalation.
Potassium below 2.5 mmol/L, glucose below 3 mmol/L, falling phosphate, symptomatic or marked hyponatraemia, or evidence of organ failure is a medical emergency regardless of diagnosis or weight.
Rapid loss at any starting weight, acute intake below roughly 500 kcal/day for at least 2 days, multiple daily purging, uncontrolled exercise or serious self-harm can markedly raise overall risk.
Investigation priorities
Integrate medical history, trajectory, examination, behaviour, psychiatric risk and support.
Management branches
An eating-disorder patient presents with collapse, acute refusal, abnormal observations or concerning behaviour.
- Perform ABCDE, glucose, ECG and urgent blood sampling while treating immediately reversible threats.
- Call senior medical or paediatric staff and specialist eating-disorder or liaison psychiatry colleagues without making either review conditional on the other.
- Use the active MEED domains to select acute ward, monitored bed, HDU or specialist unit and document escalation thresholds.