TABLE 4.

Medical Complications Resulting From Eating Disorders

Medical Complications Resulting From Purging
1. Fluid and electrolyte imbalance; hypokalemia; hyponatremia; hypochloremic alkalosis.
2. Use of ipecac: irreversible myocardial damage and a diffuse myositis.
3. Chronic vomiting: esophagitis; dental erosions; Mallory-Weiss tears; rare esophageal or gastric rupture; rare aspiration pneumonia.
4. Use of laxatives: depletion of potassium bicarbonate, causing metabolic acidosis; increased blood urea nitrogen concentration and predisposition to renal stones from dehydration; hyperuricemia; hypocalcemia; hypomagnesemia; chronic dehydration. With laxative withdrawal, may get fluid retention (may gain up to 10 lb in 24 h).
5. Amenorrhea (can be seen in normal or overweight individuals with bulimia nervosa), menstrual irregularities, osteopenia.
Medical Complications From Caloric Restriction
1. Cardiovascular Electrocardiographic abnormalities: low voltage; sinus bradycardia (from malnutrition); T wave inversions; ST segment depression (from electrolyte imbalances). Prolonged corrected QT interval is uncommon but may predispose patient to sudden death. Dysrhythmias include supraventricular beats and ventricular tachycardia, with or without exercise. Pericardial effusions can occur in those severely malnourished. All cardiac abnormalities except those secondary to emetine (ipecac) toxicity are completely reversible with weight gain.
2. Gastrointestinal system: delayed gastric emptying; slowed gastrointestinal motility; constipation; bloating; fullness; hypercholesterolemia (from abnormal lipoprotein metabolism); abnormal liver function test results (probably from fatty infiltration of the liver). All reversible with weight gain.
3. Renal: increased blood urea nitrogen concentration (from dehydration, decreased glomerular filtration rate) with increased risk of renal stones; polyuria (from abnormal vasopressin secretion, rare partial diabetes insipidus). Total body sodium and potassium depletion caused by starvation; with refeeding, 25% can get peripheral edema attributable to increased renal sensitivity to aldosterone and increased insulin secretion (affects renal tubules).
4. Hematologic: leukopenia; anemia; iron deficiency; thrombocytopenia.
5. Endocrine: euthyroid sick syndrome; amenorrhea; osteopenia.
6. Neurologic: cortical atrophy; seizures.