Anorexia Nervosa and Bulimia Nervosa

1. Anorexia Nervosa and Bulimia Nervosa Tintinalli Chapter 291

2. Introduction • 5-10% of adolescent girls & 1% of males • Anorexia - onset usually around 12 or mid 30s • Bulimia – onset between 17-25

3. Clues to Anorexia/Bulemia • Clues for Anorexia: growth retardation, primary amenorrhea, excessive weight loss, exercise abuse, hypercholesterolemia • Clues for Bulemia: hypokalemia, parotid/submandibular gland enlargement, esophageal bleeding/rupture, large weight fluctuations, secondary amenorrhea, severe dental caries, juvenile diabetes

4. Diagnostic Criteria • Anorexia: • Wt. loss > 15% of IBW • Intense fear of gaining weight or becoming fat despite being underweight • Distorted body image, over-concern with wt/shape • Amenorrhea for >3 consecutive menstrual cycles

5. Diagnostic Criteria • Bulemia: • Binge eating with a sense of lacke of control during the episode • Purging in appropriate compensatory behavior in order to prevent weight gain • Self evaluation is overly dependent on weight and body shape • Binging and purging must occur at least twice weekly for at least 3 months

6. Complications • Cardiac: arrhythmias, cardiac arrest, Q-T prolongation • Gastro: constipation, ileus, exacerbation of hepatic encephalopathy • Metabolic: glucose intolerance, hypokalemic metabolic alkalosis • Neuromuscular/ortho: hyporeflexia, peripheral neuropathy, rhabdomyolysis, weakness, pathologic fractures • Renal: decreased urinary concentrating ability; polyuria and polydipsia, nephropathy; myoglobinuira

7. Prognosis • 30% improvement, but usually a chronic disorder • Mortality figures range from 2-5% to as high as 18% • Abnormally low albumin or low body weight (<60% IBW) = increase mortality

8. Disposition • Hospitalize: • > 30% weight loss over 3 months • Severe metabolic disturbance • Depression or suicide risk • Severe bingeing and purging • Psychosis • Complex differential diagnosis

9. The End