Table 5

Serious medical indicators of REDs and/or EDS requiring immediate medical attention, potential hospitalisation and removal from training and competition (adapted from ED clinical management recommendations, paediatric and adult ED papers and athlete cardiovascular health consensus papers.294 295 313 315 316 322 323 Disclaimer: this list should not be used in isolation and should be based on a thorough clinical assessment that considers the severity of the athlete’s physical and mental health.

Serious medical indicators

  • ≤75% median BMI for age and sex

  • Electrolyte disturbances (eg, hypokalaemia, hyponatraemia, hypophosphataemia)

  • ECG abnormalities (eg, prolonged QTc interval or severe bradycardia (adult: HR≤30 bpm; adolescent: HR≤45 bpm))

  • Severe hypotension: ≤90/45 mm Hg

  • Orthostatic intolerance (adult and adolescent: a supine to standing systolic BP drop>20 mm Hg and a diastolic drop>10 mm Hg)

  • Failure of outpatient ED treatment programme

  • Acute medical complications of malnutrition (eg, syncope, seizures, cardiac failure, pancreatitis)

  • Any condition that inhibits medical treatment and monitoring while training and/or competing

  • BMI, body mass index; BPM, beats per minute; ECG, electrocardiogram; ED, eating disorder; HR, heart rate; QTc, corrected QT.