Bulimia nervosa: Difference between revisions
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==Background== | ==Background== | ||
*Pattern of binging then purging with self-induced [[vomiting]] or abuse of [[laxatives]]/[[diuretics]] abuse | |||
*Pattern of binging | |||
*Most commonly late adolescent females | *Most commonly late adolescent females | ||
* | *Typically normal to high BMI | ||
*More common than anorexia | |||
==Clinical Features== | ==Clinical Features== | ||
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===Signs=== | ===Signs=== | ||
*Dental enamel loss | *Dental enamel loss | ||
*Scarring of dorsal fingers, hand | *Scarring/erosions of dorsal fingers, hand from self-induced emesis | ||
*Salivary gland | *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 | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*Major depressive disorder, with atypical features | *Major depressive disorder, with atypical features | ||
*[[Borderline personality disorder]] | *[[Borderline personality disorder]] | ||
*Organic causes of [[nausea/vomiting]] | |||
==Labs== | ==Labs== | ||
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*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== | ||
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==References== | ==References== | ||
https://pedemmorsels.com/eating-disorders/ | |||
<references/> | <references/> | ||
[[Category:Psychiatry]] [[Category:Pediatrics]] | [[Category:Psychiatry]] [[Category:Pediatrics]] | ||
Revision as of 18:29, 14 September 2019
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
- Arrhythmias secondary to hypokalemia, particularly with binge-purge subtype
- Metabolic alkalosis
- Dehydration, chronic contraction alkalosis
- Hypokalemia, hypochloremia
- GI complications
Differential Diagnosis
- 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
- 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
- Consider admission for:
- Bradycardia <50 BPM
- Syncope (potentially concerning for arrhythmia)
- Severe electrolyte derangement
- Suicidal ideation, concurrent psychiatric disorder
See Also
References
https://pedemmorsels.com/eating-disorders/
- ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- ↑ Mehler PS. Bulimia nervosa. N Engl J Med 2003;349:876.
- ↑ Metabolic Abnormalities in Bulimia Nervosa. Am Fam Physician. 2004 Mar 15;69(6):1530-1532.