bodily substances with anorexia ner...

bodily substances with anorexia nervosa eventually become visibly recognizable because of their painfully underweight status. In contrast, those affected through bulimia are typically of normal weight and are not as easily discovered This disorder is characterized by the agency of binge eating and purging. Mehler reviews the diagnosis and treatment of bulimia, using a hypothetical case of a 20-year-old woman noted to have censorious hypokalemia and metabolic alkalosis.

Bulimia is principally common in late adolescent females. Comorbidity with other psychiatric disorders is typical, and patients with a concomitant personality disorder (eg borderline, narcissistic, and antisocial disorders) have a worse prognosis. Although most numerous bulimics purge by vomiting, abuse of laxatives or diuretics also be met withs The number of times a bulimic patient defecates can vary widely, from as seldom as one time or twice weekly to as frequently as 10 times per day.

The medical complications of bulimia relate to the manner and frequency of purging. Repeatedly induced vomiting can lead to the los of dental enamel, increased dental caries, swollen salivary glands, Mallory-Weiss esophageal tears, and gastroesophageal ebb Laxative abusers can develop rigid constipation on withdrawal of laxatives, related to damage to the myenteric plexus. The typical electrolyte abnormalities associated with bulimia are hypokalemia and metabolic acidosis. Different purging regularitys result in different constellations of serum and urine electrolyte disturbances (see accompanying table). The author notes that although bitter hypokalemia in an otherwise healthy young female specifically hints bulimia, most patients who defecate do not develop electrolyte abnormalities. Therefore, screening for hypokalemia or other electrolyte derangements is not a sensitive means for detecting purging.

Treatment of the medical complications associated with bulimia is usually possible, further the underlying disorder can be challenging to manage. Fluoridated mouthwash and toothpaste can help ameliorate dental caries, and the use of sour candies may decrease salivary gland swelling. Antacid medications help form reflux symptoms, and nonstimulant laxatives may be used to decrease constipation in those with previous stimulant laxative abuse. Oral repletion of subdued potassium is typically accomplished with 40 to 80 mEq for day of supplementary potassium, until a normal serum potassium flat is achieved. Patients with strict hypokalemia and metabolic alkalosis ne bulk repletion with intravenous normal saline to move round off the renin-angiotensin-aldosterone system and allow normalization of potassium levels

Cognitive-behavioral therapy has demonstrated efficacy in the treatment of bulimia, further more than 60 percent of patients in the same follow-up survey cited by the author still had residual eating disorder features six years after treatment. Disturbances in serotonergic orders have been postulated as contributing to bulimia. The selective serotonin reuptake inhibitor fluoxetine is the alone medication that has been approved from the U.S. Food and physic Administration for treatment of bulimia. Higher dosages of fluoxetine, up to 60 mg daily, may be necessary for effective superintendence Even with a combination of psychotherapy and pharmacologic treatment, remission rates in studies of bulimic patients averaged les than 50 percent

Mehler P Bulimia nervosa. N Engl J M August 28 2003;349:875-81

COPYRIGHT 2004 American Academy of Family Physicians

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