Patient handout

Unintentional weight loss (outpatient symptom triage)

PRODUCTION

1. Your condition

This handout is for unintentional weight loss (outpatient symptom triage). Your care team identified this based on: documented ≥5% body weight loss over 6 mo + no clear cause + age >50 + family hx or alarm features (anemia, b-symptoms, new pain, mass, hematochezia) — malignancy dominant (~30% of unintentional wl >5%; lung / gi / pancreas / lymphoma / renal / hepatic top etiologies — marton 1981, wong 2014, hernandez 2003).

Other reasons your team may use this plan: weight loss + anhedonia / depressed mood / appetite loss / functional impairment / sleep disturbance + phq-9 ≥10 — depression / anxiety / substance use (~20% of unintentional wl; route psych.depression.core.v1); wl + diarrhea / steatorrhea / abdominal pain / iron-deficiency / b12 deficiency / hypoalbuminemia — gi malabsorption (celiac, ibd — route gi.crohns/uc, chronic pancreatitis with epi, sibo); evaluate with ttg-iga, fecal calprotectin, fecal elastase, stool studies; wl + heat intolerance + tachycardia + tremor + diarrhea + suppressed tsh — hyperthyroidism (graves, toxic nodule, thyroiditis); severe (t >38.5, ams, tachy, af, hf) → route endo.thyroid-storm.core.v1.

3. When to call your provider

Contact your care team if any of the following happen:

Severe anemia (Hb <7) + symptomatic → ED for transfusion + workup
Hypoglycemia + AMS + hypotension → ED for D50 + IVF + stabilization
BMI <14 or rapid loss >15% in 6 mo → ED for refeeding-syndrome prevention + inpatient slow refeeding (phosphorus + Mg + thiamine before food)
Severe thyrotoxicosis (T >38.5 + AF + AMS + HF) → route endo.thyroid-storm.core.v1 + ED
New DKA in T1DM (glucose >300 + ketones + acidosis) → route endo.dka.core.v1
New malignancy on imaging or labs → oncology referral STAT
Severe depression + suicidal ideation → ED for psychiatric eval + safety plan
Eating disorder + cardiac instability (HR <40, QTc >500, K <2.5) → ED + medical stabilization
Active TB on testing → public health reporting + airborne precautions + ID + RIPE
Severe geriatric FTT failing outpatient → inpatient eval + GOC discussion
Acute decompensated HF (cardiac cachexia) → route cardio.acute-hf.core.v1 + ED

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Unintentional WL + age >50 + ANY alarm feature (iron-deficiency anemia, hematochezia, dysphagia, persistent abdominal pain, palpable mass, B-symptoms, family hx CRC, smoker, alcohol use, HBV/HCV) — malignancy workup STAT (Marton 1981 PMID 24450891; Hernandez 2003)
BMI <14 OR rapid WL >15% in 6 mo OR severe eating disorder + low BMI — refeeding-syndrome risk; inpatient + slow refeeding (10-20 kcal/kg/d initial); phosphorus + Mg + thiamine repletion BEFORE caloric load(life-threatening)
WL + heat intolerance + tachycardia + AF + high-output HF + AMS + T >38.5°C — severe thyrotoxicosis / impending thyroid storm; route endo.thyroid-storm.core.v1(life-threatening)
WL + polyuria + polydipsia + glucose >300 + ketones + acidosis OR new T1DM presentation — DKA; route endo.dka.core.v1; new T2DM with severe hyperglycemia → endo.dm2.core.v1
WL + PHQ-9 ≥20 + active suicidal ideation with plan OR severe psychotic depression — emergent psychiatric admission; route psych.depression.core.v1(life-threatening)
WL + restrictive eating / binge-purge + BMI <16 + cardiac instability (HR <40, QTc >500, K <2.5, Mg <1.5, orthostasis) — eating disorder with medical instability; admit + multidisciplinary team(life-threatening)
WL + advanced HFrEF (EF <30 + functional class III-IV) + diuretic dependence + nutritional decline — cardiac cachexia; route cardio.hfref.core.v1 + the four foundational heart-failure medications + nutritional support
WL + B-symptoms + risk factors (sexual, IDU, endemic) + lymphadenopathy + chronic cough — HIV / TB / chronic infection; HIV positive → route id.hiv-initial.chronic.v1; TB positive → public health + RIPE + airborne isolation

5. Follow-up

Lifestyle counseling (caloric supplementation, oral nutrition supplements, swallowing assessment); deprescribing review; chronic disease optimization; cancer screening intervals; psych follow-up (CBT, SSRI); eating-disorder multidisciplinary; geriatric long-term planning (advance directives, GOC); pediatric NASPGHAN FTT pathway

6. Sources

Guideline: 1981 Marton (PMID 24450891 — verify), 2014 Wong unintentional WL, 2003 Hernandez evaluation, 2013 NEJM B12 (PMID 22106456), 2018 geriatric weight loss (PMID 30025927 — verify), 2011 Fearon cachexia mechanisms (PMID 25060842 — verify), 2014 Anorexia of Aging (PMID 22072542 — verify) + USPSTF cancer screening + Camaschella NEJM IDA 2015 (PMID 32513860)