Medical complications of anorexia nervosa and bulimia nervosa.

The internist plays a critical role in the care of eating disorder patients, especially in the management of the life-threatening medical complications of these conditions. In anorexia nervosa, the immediate danger is related to the effects of voluntary starvation, including hypophosphatemia, bone marrow failure, cardiac decompensation, and shock. Patients with bulimia nervosa more often experience severe fluid and electrolyte abnormalities resulting in hypovolemia, secondary hyperaldosteronism, depletion of total body potassium, and cardiac arrhythmias. Immediate management of medical complication and correction of nutritional deficits are necessary before patients can benefit from psychotherapy. The need for continued involvement of the internist in the ongoing care of the eating disorder patient is stressed. The high mortality and the likelihood of chronicity without early intervention underscore the need for early recognition and skilled management of eating disorders.

[1]  M. Hall-Craggs,et al.  Surreptitious habitual vomiting simulating Bartter's syndrome. , 1980, JAMA.

[2]  L. Hsu,et al.  The outcome of anorexia nervosa: a reappraisal , 1988, Psychological Medicine.

[3]  E. R. McAnarney,et al.  Rib fractures and anorexia nervosa. , 1983, Journal of adolescent health care : official publication of the Society for Adolescent Medicine.

[4]  Lucas Ar.  On the meaning of laboratory values in anorexia nervosa. , 1977 .

[5]  J. Silverman,et al.  Anorexia nervosa: clinical observations in a successful treatment plan. , 1974, The Journal of pediatrics.

[6]  M. Pertschuk,et al.  Immunocompetency in anorexia nervosa. , 1982, The American journal of clinical nutrition.

[7]  R. Malt,et al.  Nutritional support of hospitalized patients. , 1981, The New England journal of medicine.

[8]  A. Andersen.  Anorexia nervosa: who are you? Where are you? , 1988, Mayo Clinic proceedings.

[9]  P. Garfinkel,et al.  Anorexia Nervosa : A Multidimensional Perspective , 1982 .

[10]  F. Lifshitz,et al.  Fear of obesity. A cause of short stature and delayed puberty. , 1983, The New England journal of medicine.

[11]  M. Corey,et al.  Changes in body composition during refeeding of patients with anorexia nervosa. , 1988, The Journal of pediatrics.

[12]  R. Kempson,et al.  Surreptitious diuretic ingestion and pseudo-Bartter's syndrome. , 1982, The American journal of medicine.

[13]  Weller Ra,et al.  Anorexia nervosa in a patient with an infiltrating tumor of the hypothalamus. , 1982 .

[14]  G. Comerci,et al.  Eating disorders in the young anorexia nervosa and bulimia: Part I. , 1985, Current problems in pediatrics.

[15]  P J Cooper,et al.  Self-induced vomiting and bulimia nervosa: an undetected problem. , 1982, British medical journal.

[16]  R. Palmer,et al.  How Common is Anorexia Nervosa? A Prevalence Study , 1976, British Journal of Psychiatry.

[17]  J. Davis,et al.  An evaluation of trace metals, vitamins, and taste function in anorexia nervosa. , 1980, The American journal of clinical nutrition.

[18]  L. Hsu.  Outcome of anorexia nervosa. A review of the literature (1954 to 1978). , 1980, Archives of general psychiatry.

[19]  R. Schrier.  Renal and Electrolyte Disorders , 1976 .

[20]  N. Kalin,et al.  A follow‐up study of thirty hospitalized bulimics. , 1987, Psychosomatic medicine.

[21]  A. Yates,et al.  Running--an analogue of anorexia? , 1983, The New England journal of medicine.

[22]  R. D. Goldney.  Craniopharyngioma simulating anorexia nervosa. , 1978, The Journal of nervous and mental disease.

[23]  J. Mitchell,et al.  Medical complications and medical management of bulimia. , 1987, Annals of internal medicine.

[24]  S. Theander.  Research on outcome and prognosis of anorexia nervosa and some results from a swedish long‐term study , 1983 .

[25]  R. Weinsier,et al.  Death resulting from overzealous total parenteral nutrition: the refeeding syndrome revisited. , 1981, The American journal of clinical nutrition.

[26]  A. Stunkard,et al.  Bulimia vs bulimic behaviors on a college campus. , 1987, JAMA.

[27]  N. Kalin,et al.  Depression in bulimia at 2- to 5- year followup , 1985, Psychiatry Research.

[28]  L. Hsu.  The gender gap in eating disorders: Why are the eating disorders more common among women? , 1989 .

[29]  G. Patton.  Mortality in eating disorders , 1988, Psychological Medicine.

[30]  D. Yurgelun-Todd,et al.  Prevalence of anorexia nervosa and bulimia in three student populations , 1984 .

[31]  K. Lewin,et al.  Anorexia nervosa associated with hypothalamic tumour. , 1972, British medical journal.

[32]  S. Abraham,et al.  Bulimia: A study of outcome , 1983 .

[33]  W. O'Fallon,et al.  Anorexia nervosa in Rochester, Minnesota: a 45-year study. , 1988, Mayo Clinic proceedings.

[34]  S. Theander,et al.  Outcome and prognosis in anorexia nervosa and bulimia: some results of previous investigations, compared with those of a Swedish long-term study. , 1985, Journal of psychiatric research.

[35]  E. Steiger,et al.  Nutritional support of the critically ill child. , 1980, Pediatric clinics of North America.

[36]  R. T. Harris.  Bulimarexia and related serious eating disorders with medical complications. , 1983, Annals of internal medicine.

[37]  D. Christie,et al.  An adolescent with vomiting and weight loss. , 1984, Journal of adolescent health care : official publication of the Society for Adolescent Medicine.

[38]  M. King,et al.  THE "EPIDEMIC" OF ANOREXIA NERVOSA: ANOTHER MEDICAL MYTH? , 1987, The Lancet.

[39]  W. Anyan.  Changes in erythrocyte sedimentation rate and fibrinogen during anorexia nervosa. , 1974, The Journal of pediatrics.

[40]  R. Bryant-Waugh,et al.  Long term follow up of patients with early onset anorexia nervosa. , 1988, Archives of disease in childhood.

[41]  H. Pearson,et al.  Marrow hypoplasia in anorexia nervosa. , 1967, The Journal of pediatrics.

[42]  Comerci Gd.  Fluid and electrolyte and drug therapy considerations in the management of eating disorders. , 1986 .

[43]  I. Litt,et al.  Medical complications of eating disorders in adolescents. , 1988, Pediatrics.

[44]  James E Mitchell,et al.  The increasing prevalence of bulimia in freshman college students , 1986 .

[45]  M. Reidenberg,et al.  Symptomatic hypokalemia resulting from surreptitious diuretic ingestion. , 1981, JAMA.

[46]  C. Fairburn,et al.  The Depressive Symptoms of Bulimia Nervosa , 1986, British Journal of Psychiatry.

[47]  E. Lightner,et al.  Bromocriptine-unresponsive prolactin macroadenoma in a prepubertal female. , 1988, Journal of adolescent health care : official publication of the Society for Adolescent Medicine.

[48]  M. Taylor,et al.  The Prevalence of Bulimia Nervosa , 1987, British Journal of Psychiatry.

[49]  R. P. Thompson,et al.  Crohn's disease presenting as anorexia nervosa , 1988, British medical journal.