Approach to feeding and eating disorders Quiz: Ace Your Exams

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A 29-year-old woman comes to the emergency department for evaluation after a syncopal episode. The event occurred one hour prior to arrival after she stood up from the couch. It was witnessed by her partner, who reports loss of consciousness lasting a few seconds. She did not hit her head, and there was no seizure activity noted. During the past year, she has had several episodes of syncope that have increased in frequency. The patient has a history of anorexia nervosa, with prior outpatient treatment six months ago. Temperature is 36.5°C (97.7°F), pulse is 39/min, respirations are 15/minute, blood pressure is 84/58 mmHg, and body mass index (BMI) is 15 kg/m2. The patient is dysphoric in effect, but able to cooperate and follow commands. Cardiopulmonary examination is normal other than bradycardia. Abdominal examination is normal. Lanugo is noted on the arms. Gait is unsteady, but the neurologic examination is otherwise within normal limits. Electrocardiogram shows sinus bradycardia without other abnormalities. Comprehensive metabolic panel is within normal limits. Which of the following is the best next step in management? 

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