Bulimia nervosa
Background
- Usually normal BMI or slightly overweight
- 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
- Associated with borderline, narcissistic personality disorders
Clinical Features
- Dental enamel loss
- Scarring of dorsal fingers, hand
- Salivary gland swelling
DDx
General Psychiatric
- Organic causes
- Psychiatric causes
Labs
- Dependent on type of purging
- Electrolytes[1]
| ' | Na+ | K+ | Cl- | Bicarb | pH |
| Vomiting | Variable | ↓ | ↓ | ↑ | ↑ |
| Laxatives | Nl to ↑ | ↓ | Variable | Variable | Variable |
| Diuretics | ↓ to nl | ↓ | ↓ | ↑ | ↑ |
Management[2]
- IVF volume replacement
- Potassium oral replacement 40-80 mEq/day
- Referral to psych for CBT