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What are the complications of bulimia nervosa?
"You think you're invincible. I had 15 years of nothing. Then heart problems and I'm on medication now for the rest of my life," said a recovering patient.

The complications of bulimia nervosa are serious and can adversely affect teeth, the esophagus, the reproductive cycle and hormones, and electrolyte balances, which in turn can affect the heart. Some of the complications can be life threatening. In addition, patients with underlying depression may be at risk of suicide.

Stomach acid can erode the enamel of teeth, exposing soft dentin and making the teeth more susceptible to cavities. This erosion may be prevented by using fluoride applications, taking mineral supplements, and rinsing with water or a baking soda solution after purging. Brushing the teeth after vomiting is harmful because it rubs off the weakened enamel. Dentists have many ways to repair eroded enamel, including fillings, composites, root canals, crowns, and dentures. However, most dentists advise against performing these restorative procedures until the patient is in recovery from bulimia nervosa.

Electrolyte imbalances are common in patients with more severe bulimic symptoms, occurring in up to 49% of patients. These imbalances occur when ionized salt concentrations (commonly sodium and potassium) are at abnormal levels in the body. Potentially fatal irregular heart rhythms can occur as a result, so testing patients for these imbalances is very important. Certain electrolyte imbalances—hypokalemia (potassium too low), metabolic alkalosis (blood too alkaline), and hypochloremia (chloride too low) occur more often in patients who purge through vomiting or abuse diuretics.

The menstrual cycles of females with bulimia nervosa can be altered, although few patients have long-term cessation of menses, and many patients maintain their normal level of sexual activity. Some studies show that bulimic symptoms and behaviors improve during pregnancy in many women, but few recover totally. Also, bulimic pregnant women can experience complications during pregnancy directly associated with the bulimic behavior.

A number of medical tests (see chart) may be ordered during the course of diagnosing, treating, and monitoring the patient during treatment of bulimia nervosa. Many of these tests are also used for other eating disorders. Which, if any, tests are used will depend on each patient's medical status.

Medical tests to diagnose bulimia nervosa and monitor treatment

  • Complete blood count with differential
  • Urinalysis
  • Complete metabolic profile: sodium, chloride, potassium, glucose, blood urea
  • nitrogen, creatinine, total protein, albumin, globulin, calcium, carbon dioxide, asat, alkaline phosphates, total bilirubin
  • Serum magnesium
  • Thyroid screen (T3, T4, TSH)
  • Electrocardiogram

Tests used if the patient is:

15% to 20% or more below ideal body weight (usually applies to anorexia, but some bulimia patients can also be underweight)
  • Chest x-ray
  • Complement 3
  • 24-hour creatinine clearance
  • Uric acid
  • Low weight lasting 6 months or longer, bone mineral density scan and estadiol ID
  • level in females or testosterone in males
  • Echocardiogram
  • Brain scan, if neurologic signs

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Bulimia nervosa is an eating disorder in which a person engages in binge eating (eating a lot of food in a short time) followed by some type of behavior to prevent weight gain from the food that was eaten. This behavior can take two forms: self-induced vomiting, misuse of enemas, laxatives, diet pills (called purging) and excessive exercise, fasting, or diabetic omission of insulin (called non-purging). Some people with bulimia nervosa may also starve themselves for periods of time before binge eating again. Bulimia nervosa has important mental, emotional, and physical aspects that require consideration during treatment.

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