Epidemiology

Etiology

Pathophysiology

Clinical features

• BMI: can be normal or slightly elevated
• Central nervous system: Seizures
  • As a result of dehydration and electrolyte imbalances (e.g., hyponatremia)
• Cardiovascular symptoms: Cardiac arrhythmias, hypotension
  • Mainly caused by potassium deficiency
  • As a result of decreased sympathetic nervous system activity
• Gastrointestinal tract
  • Esophagitis and/or gastritis
  • Esophageal/gastric lacerations (Mallory-Weiss syndrome)
  • Bilateral parotid gland swelling (sialadenosis)
• Skin: Calluses on the knuckles (Russell sign)
• Teeth: Caries and perimylolysis due to frequent vomiting

Diagnostics

• ↓ Potassium, ↓ sodium, ↓ chloride, and ↓ calcium
• Metabolic alkalosis
• Possible ↑ serum α-amylase

Differential diagnostics

Treatment

• Comanage nutritional management with a dietitian.
  • Provide nutritional education.
  • Promote healthy eating habits.
• Refer all patients for psychotherapy; consider pharmacotherapy only as adjunctive therapy.
  • Preferred initial management in adults: cognitive behavioral therapy with or without an SSRI (fluoxetine)
  • Preferred initial management in adolescents and young adults: family-based therapy with an involved caregiver

Pharmacotherapy

• Fluoxetine
  • Preferred pharmacotherapy agent for bulimia nervosa
  • Can reduce binge eating episodes and purging