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 gt 15 of IBW
• Intense fear of gaining weight or becoming fat
  despite being underweight
• Distorted body image, over-concern with wt/shape
• Amenorrhea for gt3 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 (lt60
  IBW) increase mortality

8
Disposition

• Hospitalize
• gt 30 weight loss over 3 months
• Severe metabolic disturbance
• Depression or suicide risk
• Severe bingeing and purging
• Psychosis
• Complex differential diagnosis

9
The End