Complications
Loss of fluid by vomiting coupled with decreased intake.
Presents with muscle cramping that usually occurs at night in the legs, impaired accommodation of the eyes (leading to loss of focus after 15 to 30 minutes of reading), impaired short-term memory, and weakness.
The enamel of the teeth is gradually eroded, resulting in increased sensitivity to hot and cold liquids and solids.
Brushing one’s teeth immediately after vomiting may hasten this erosion. Therefore, patients should be advised to rinse with water, followed by a sodium fluoride rinse, and to disclose their illness to their dentist.[121]
Occurs in bulimia nervosa due to supersaturation of bile salts with cholesterol if there are marked shifts in weight. Cardinal symptom is usually steady, sudden-onset abdominal pain radiating to the back. Typical signs include epigastric tenderness, fever, and tachycardia. Initial treatment involves resuscitation with intravenous fluids and correction of electrolyte abnormalities, analgaesia, and tight glucose control. In addition, the underlying bulimia should be addressed.
Presents with gradual onset of increased shortness of breath on exertion that may progress to ankle swelling and orthopnoea. It is almost always reversible if ipecac use is discontinued and is rarely seen now because of its increased recognition by pharmacists and physicians.
One 12-year longitudinal study compared the incidence of cardiovascular disease in 818 women who were hospitalised for bulimia nervosa with over 400,000 matched controls. Women hospitalised for bulimia nervosa were found to be at increased risk of ischaemic heart disease (HR 6.63, 95% CI 3.34 to 13.13), atherosclerosis (HR 6.94, 95% CI 3.08 to 15.66), and cardiac conduction defects (HR 2.99, 95% CI 1.57 to 5.71). Hospitalisation with bulimia nervosa was also associated with nearly 22 times the risk of myocardial infarction at 2-year follow-up, and 14 times the risk at 5-year follow-up.[122]
May cause muscle weakness and cramps.
Palpitations usually occur immediately after purging and are caused by the stress of purging and volume depletion. This is usually benign.
Palpitations that become more frequent, last >15 minutes, or result in loss of consciousness, seizure, or collapse should be investigated.
Haematemesis is usually not significant if it involves the vomiting of a total blood volume of <15 mL. Even larger volumes are usually due to a Mallory-Weiss tear, which typically requires no intervention. However, any patient who vomits >15 mL of blood should be evaluated in the emergency department.
Presents as severe chest pain followed shortly by collapse.
The lifetime prevalence rate for suicide attempts for people with bulimia nervosa has been estimated at 34%, significantly higher than for people without a specific eating disorder diagnosis (OR 6.33, 95% CI 3.39 to 11.81).[123]
Bulimia nervosa is associated with an elevated risk of death due to suicide.[124] Death may also result from medical complications such as pancreatitis and arrhythmia.
The risk of death is much higher among patients with bulimia nervosa who have concurrent alcohol-use disorder. The standardised mortality ratio for bulimia is 2, or twice the normal rate.[125]
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