Bulimia nervosa - Revision history

Elcatracho: /* Complications */

2021-02-09T15:32:39Z

Complications

← Older revision		Revision as of 15:32, 9 February 2021
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	**Heartburn, [[GERD]]		**Heartburn, [[GERD]]
	**Cathartic colon syndrome from chronic laxative abuse damaging intestinal nerve cells		**Cathartic colon syndrome from chronic laxative abuse damaging intestinal nerve cells
			*Must avoid use of [[bupropion]] as it may lead to seizures in patients with eating disorders

	==Differential Diagnosis==		==Differential Diagnosis==

ClaireLewis at 18:29, 14 September 2019

2019-09-14T18:29:35Z

← Older revision		Revision as of 18:29, 14 September 2019
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	==Background==		==Background==
	*Usually normal BMI or slightly overweight		*Pattern of binging then purging with self-induced [[vomiting]] or abuse of [[laxatives]]/[[diuretics]] abuse
	*Pattern of binging ~~and~~ purging with vomiting~~, laxative~~/~~diuretic~~ abuse
	*Purges from as often as 1-2/wk to 10x/day
	*Most commonly late adolescent females		*Most commonly late adolescent females
	*~~Associated with borderline, narcissistic personality disorders~~		*Typically normal to high BMI
			*More common than anorexia

	==Clinical Features==		==Clinical Features==
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	===Signs===		===Signs===
	*Dental enamel loss		*Dental enamel loss
	*Scarring of dorsal fingers, hand		*Scarring/erosions of dorsal fingers, hand from self-induced emesis
	*Salivary gland ~~swelling~~		*Salivary gland hypertrophy (painless, bilateral)

			===Complications===
			*[[Arrhythmias]] secondary to [[hypokalemia]], particularly with binge-purge subtype
			*[[Metabolic alkalosis]]
			*[[Dehydration]], chronic contraction alkalosis
			*[[Hypokalemia]], hypochloremia
			*GI complications
			**Odynophagia, [[dysphagia]], hoarseness
			**Heartburn, [[GERD]]
			**Cathartic colon syndrome from chronic laxative abuse damaging intestinal nerve cells

	==Differential Diagnosis==		==Differential Diagnosis==
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	*Major depressive disorder, with atypical features		*Major depressive disorder, with atypical features
	*[[Borderline personality disorder]]		*[[Borderline personality disorder]]
			*Organic causes of [[nausea/vomiting]]

	==Labs==		==Labs==
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	*Potassium oral replacement 40-80 mEq/day		*Potassium oral replacement 40-80 mEq/day
	*Referral to psych for CBT		*Referral to psych for CBT

			==Disposition==
			*Consider admission for:
			**[[Bradycardia]] <50 BPM
			**[[Syncope]] (potentially concerning for arrhythmia)
			**Severe electrolyte derangement
			**[[Suicide\|Suicidal ideation]], concurrent psychiatric disorder

	==See Also==		==See Also==
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	==References==		==References==
			https://pedemmorsels.com/eating-disorders/
	<references/>		<references/>

	[[Category:Psychiatry]] [[Category:Pediatrics]]		[[Category:Psychiatry]] [[Category:Pediatrics]]

Humanguy: Deleted general psych differential, created new list

2016-11-11T08:57:28Z

Deleted general psych differential, created new list

← Older revision		Revision as of 08:57, 11 November 2016
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	*Salivary gland swelling		*Salivary gland swelling

	==~~DDx~~==		==Differential Diagnosis==
	~~{{Psych DDX}}~~		*[[Anorexia nervosa]], binge eating/purging type
			*Binge-eating disorder
			*Klein-Levin syndrome
			*Major depressive disorder, with atypical features
			*[[Borderline personality disorder]]

	==Labs==		==Labs==

Humanguy: Added diagnostic criteria

2016-11-11T08:49:58Z

Added diagnostic criteria

@@ Line 7: / Line 7: @@
 ==Clinical Features==
 *Dental enamel loss
 *Scarring of dorsal fingers, hand

Neil.m.young: Text replacement - "==Sources==" to "==References=="

2016-06-26T17:49:57Z

Text replacement - "==Sources==" to "==References=="

← Older revision		Revision as of 17:49, 26 June 2016
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	*[[Anorexia nervosa]]		*[[Anorexia nervosa]]

	==~~Sources~~==		==References==
	<references/>		<references/>

	[[Category:Psychiatry]] [[Category:Pediatrics]]		[[Category:Psychiatry]] [[Category:Pediatrics]]

Ostermayer: Text replacement - "Category:Psych" to "Category:Psychiatry"

2016-03-22T16:02:56Z

Text replacement - "Category:Psych" to "Category:Psychiatry"

← Older revision		Revision as of 16:02, 22 March 2016
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	<references/>		<references/>

	[[Category:~~Psych~~]] [[Category:Pediatrics]]		[[Category:Psychiatry]] [[Category:Pediatrics]]

Ostermayer: Text replacement - "Category:Peds" to "Category:Pediatrics"

2016-03-22T15:59:57Z

Text replacement - "Category:Peds" to "Category:Pediatrics"

← Older revision		Revision as of 15:59, 22 March 2016
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	<references/>		<references/>

	[[Category:Psych]] [[Category:~~Peds~~]]		[[Category:Psych]] [[Category:Pediatrics]]

Kxl328 at 19:54, 17 February 2016

2016-02-17T19:54:32Z

← Older revision		Revision as of 19:54, 17 February 2016
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	==Sources==		==Sources==
	</~~references~~>		<references/>

	[[Category:Psych]] [[Category:Peds]]		[[Category:Psych]] [[Category:Peds]]

Kxl328: Created page with "==Background== Usually normal BMI or slightly overweight Pattern of binging and purging with vomiting, laxative/diuretic abuse Purges from as often as 1-2/wk to 10x/day Mo..."

2016-02-17T19:54:14Z

Created page with "==Background== *Usually normal BMI or slightly overweight *Pattern of binging and purging with vomiting, laxative/diuretic abuse *Purges from as often as 1-2/wk to 10x/day *Mo..."

New page

==Background==
*Usually normal BMI or slightly overweight
*Pattern of binging and purging with vomiting, laxative/diuretic abuse
*Purges from as often as 1-2/wk to 10x/day
*Most commonly late adolescent females
*Associated with borderline, narcissistic personality disorders

==Clinical Features==
*Dental enamel loss
*Scarring of dorsal fingers, hand
*Salivary gland swelling

==DDx==
{{Psych DDX}}

==Labs==
*Dependent on type of purging
*Electrolytes<ref>Mehler PS. Bulimia nervosa. N Engl J Med 2003;349:876.</ref>
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|''''''
| align="center" style="background:#f0f0f0;"|'''Na+'''
| align="center" style="background:#f0f0f0;"|'''K+'''
| align="center" style="background:#f0f0f0;"|'''Cl-'''
| align="center" style="background:#f0f0f0;"|'''Bicarb'''
| align="center" style="background:#f0f0f0;"|'''pH'''
|-
| Vomiting||Variable||↓||↓||↑||↑
|-
| Laxatives||Nl to ↑||↓||Variable||Variable||Variable
|-
| Diuretics||↓ to nl||↓||↓||↑||↑
|-
|}

==Management<ref>Metabolic Abnormalities in Bulimia Nervosa. Am Fam Physician. 2004 Mar 15;69(6):1530-1532.</ref>==
*IVF volume replacement
*Potassium oral replacement 40-80 mEq/day
*Referral to psych for CBT

==See Also==
*[[Anorexia nervosa]]

==Sources==
</references>

[[Category:Psych]] [[Category:Peds]]