Endo Fha Inpatient Evaluation Criteria

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name: endo-fha-inpatient-evaluation-criteria
description: This skill guides clinicians to assess patients with functional hypothalamic amenorrhea (FHA) for hospital admission when they exhibit severe bradycardia, hypotension, orthostasis, or significant electrolyte abnormalities. Use when a clinician says, “Her heart rate is 40 and she’s dizzy—should we admit her?” or notes phrases like “Admit for hypotension and bradycardia” or “Check for orthostatic vitals and electrolytes.”
---

# Evaluate for inpatient treatment based on vital signs and electrolyte instability

## STEP 1 — Gather Information
Collect heart rate, blood pressure (supine and standing after 3 minutes), respiratory rate, temperature, weight, and symptoms (dizziness, syncope, fatigue). Obtain basic metabolic panel (sodium, potassium, chloride, bicarbonate, BUN, creatinine) and consider magnesium, phosphate if refeeding risk.

## STEP 2 — Rule In / Rule Out
**Rule in** inpatient evaluation if any of the following are present: heart rate <50 beats/min, systolic blood pressure <90 mmHg, orthostatic systolic drop ≥20 mmHg or diastolic drop ≥10 mmHg, or heart rate increase ≥30 bpm upon standing; or electrolyte abnormality such as potassium <3.0 mmol/L, sodium <130 mmol/L, or glucose <60 mg/dL. Otherwise, **rule out** need for immediate admission based on vitals/labs.

## STEP 3 — Classify or Stratify
Classify as **high risk** for inpatient admission if any severe vital sign or electrolyte criterion from Step 2 is met; classify as **low risk** if vitals are stable and electrolytes are within normal limits.

## STEP 4 — Decide
For high‑risk patients, admit to a monitored inpatient setting for cardiac telemetry, electrolyte repletion, and initiation of a structured refeeding plan under dietitian supervision. For low‑risk patients, arrange outpatient multidisciplinary follow‑up (nutrition, psychotherapy, endocrinology) with close safety net instructions.

## Clinical Guardrails / Mimics / Pitfalls
Do not attribute bradycardia solely to athletic training without excluding FHA; hypotension may mimic sepsis or dehydration—check volume status and consider infection. Orthostatic vitals can be falsely normal if measured too early; ensure 3‑minute standing. Avoid missing refeeding syndrome by checking phosphate and magnesium before starting nutrition. Do not delay admission for isolated mild electrolyte changes if symptomatic.

## Concrete Clinical Example
An 18‑year‑old woman with known FHA presents with HR 42 bpm, supine BP 88/52 mmHg, standing BP 70/48 mmHg after 3 min (orthostatic drop 18/4), and serum potassium 2.8 mmol/L. She reports light‑headedness. Meeting bradycardia, hypotension, orthostasis, and hypokalemia criteria, she is admitted for telemetry, potassium replacement, and supervised refeeding.

**Source:** Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline, Gordon et al., 2017, doi:10.1210/jc.2017-00131