Bulimia nervosa: Difference between revisions

(Text replacement - "Category:Peds" to "Category:Pediatrics")
 
(5 intermediate revisions by 4 users not shown)
Line 1: Line 1:
==Background==
==Background==
*Usually normal BMI or slightly overweight
*Pattern of binging then purging with self-induced [[vomiting]] or abuse of [[laxatives]]/[[diuretics]] abuse
*Pattern of binging and purging with vomiting, laxative/diuretic abuse
*Purges from as often as 1-2/wk to 10x/day
*Most commonly late adolescent females
*Most commonly late adolescent females
*Associated with borderline, narcissistic personality disorders
*Typically normal to high BMI
*More common than anorexia


==Clinical Features==
==Clinical Features==
===Diagnostic Criteria===
*A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:<ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>
**1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
**2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
*B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
*C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
*D. Self-evaluation is unduly influenced by body shape and weight.
*E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
===Signs===
*Dental enamel loss
*Dental enamel loss
*Scarring of dorsal fingers, hand
*Scarring/erosions of dorsal fingers, hand from self-induced emesis
*Salivary gland swelling
*Salivary gland hypertrophy (painless, bilateral)
 
===Complications===
*[[Arrhythmias]] secondary to [[hypokalemia]], particularly with binge-purge subtype
*[[Metabolic alkalosis]]
*[[Dehydration]], chronic contraction alkalosis
*[[Hypokalemia]], hypochloremia
*GI complications
**Odynophagia, [[dysphagia]], hoarseness
**Heartburn, [[GERD]]
**Cathartic colon syndrome from chronic laxative abuse damaging intestinal nerve cells
*Must avoid use of [[bupropion]] as it may lead to seizures in patients with eating disorders


==DDx==
==Differential Diagnosis==
{{Psych DDX}}
*[[Anorexia nervosa]], binge eating/purging type
*Binge-eating disorder
*Klein-Levin syndrome
*Major depressive disorder, with atypical features
*[[Borderline personality disorder]]
*Organic causes of [[nausea/vomiting]]


==Labs==
==Labs==
Line 37: Line 63:
*Potassium oral replacement 40-80 mEq/day
*Potassium oral replacement 40-80 mEq/day
*Referral to psych for CBT
*Referral to psych for CBT
==Disposition==
*Consider admission for:
**[[Bradycardia]] <50 BPM
**[[Syncope]] (potentially concerning for arrhythmia)
**Severe electrolyte derangement
**[[Suicide|Suicidal ideation]], concurrent psychiatric disorder


==See Also==
==See Also==
*[[Anorexia nervosa]]
*[[Anorexia nervosa]]


==Sources==
==References==
https://pedemmorsels.com/eating-disorders/
<references/>
<references/>


[[Category:Psych]] [[Category:Pediatrics]]
[[Category:Psychiatry]] [[Category:Pediatrics]]

Latest revision as of 15:32, 9 February 2021

Background

  • Pattern of binging then purging with self-induced vomiting or abuse of laxatives/diuretics abuse
  • Most commonly late adolescent females
  • Typically normal to high BMI
  • More common than anorexia

Clinical Features

Diagnostic Criteria

  • A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:[1]
    • 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
    • 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
  • B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
  • C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
  • D. Self-evaluation is unduly influenced by body shape and weight.
  • E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Signs

  • Dental enamel loss
  • Scarring/erosions of dorsal fingers, hand from self-induced emesis
  • Salivary gland hypertrophy (painless, bilateral)

Complications

Differential Diagnosis

Labs

  • Dependent on type of purging
  • Electrolytes[2]
' Na+ K+ Cl- Bicarb pH
Vomiting Variable ↓ ↓ ↑ ↑
Laxatives Nl to ↑ ↓ Variable Variable Variable
Diuretics ↓ to nl ↓ ↓ ↑ ↑

Management[3]

  • IVF volume replacement
  • Potassium oral replacement 40-80 mEq/day
  • Referral to psych for CBT

Disposition

See Also

References

https://pedemmorsels.com/eating-disorders/

  1. ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. ↑ Mehler PS. Bulimia nervosa. N Engl J Med 2003;349:876.
  3. ↑ Metabolic Abnormalities in Bulimia Nervosa. Am Fam Physician. 2004 Mar 15;69(6):1530-1532.
Retrieved from "https://www.wikem.org/w/index.php?title=Bulimia_nervosa&oldid=296370"