Eating Disorders - fieldi

14 Medical Aspects of Anorexia and Bulimia
Vomiting depletes the body of potassium and other electrolytes.
This danger is compounded by low weight, as well as abuse of
diuretics and laxatives. While many bulimics have normal blood
tests, electrolytes must be monitored to be safe (Greenfeld et al.
1995). Low potassium may cause muscle weakness, but it can be
asymptomatic and still lead to respiratory arrest or irregular heart
rhythms, causing sudden death.
Dental problems are rampant in bulimia. Enamel on the lingual
surface of the teeth becomes eroded. Cavities and gum disease are
common, and patients may lose all their teeth at an early age. Salivary
glands in the cheeks (parotids) and lymph nodes under the chin
(submandibular) are often enlarged. This can produce swelling and
a “chipmunk cheek” appearance, which usually improves once
bulimia resolves.
Most patients who abuse laxatives choose the cathartic type.
These drugs work for the bowel, causing it to be unable to function
on its own after a while. In addition, laxative abuse causes metabolic
changes that can lead to painful kidney stones. Very high doses of
laxatives that contain phenolphthalein have also been reported to
cause pancreatitis and encephalitis. Ironically, using laxatives to lose
weight is misguided, since laxatives do not remove calories. Calories are
already absorbed before food reaches the part of the colon where
laxatives work. Laxatives may cause temporary weight loss by taking
out water, but this dehydration leads to rebound fluid retention.
Bulimics who abuse laxatives may experience edema each time they
try to stop. Special treatment regimens can facilitate laxative discontinuation
without the severe water retention that plagues some
patients.
Most deadly among the forms of purging is the abuse of Ipecac, a
syrup used to induce vomiting in children who are poisoned (Greenfeld
et al. 1993). Many patients try it once and find it so unpleasant
that they avoid further use. However, the emetine in this product has
a long half-life, leaving the system extremely slowly. This means that
repeated use, even two or three times a week, can cause high levels
to accumulate in the body. Since emetine is itself a muscle poison,
ongoing use may produce myopathy with arm and leg weakness or
sudden heart failure.
Bulimia may cause both gynecological and obstetrical problems.