Internal Medicine

0521779407-B02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

264 Bulimia Nervosa

➣Methods: fingers, instruments, syrup of ipecac, laxatives (1/3 of

bulimics), enemas, diuretics

Subtypes

■Purging type: regular self-induction of emesis or the misuse of laxa-

tives, diuretics or enemas after a binge

■Non-purging type: use of non-purging compensatory methods (i.e.,

fasting or excessive exercise after a binge

Signs & Symptoms

■Loss of dental enamel: lingual surface, front teeth

■Increased frequency of dental cavities

■Enlarged salivary (parotid) glands

■Calluses or scars on dorsal surface of hands from repeated trauma

from the teeth during emesis induction and gagging

■Cardiac and skeletal myopathies secondary to repeated ipecac mis-

use

tests

■Fluid and electrolyte abnormalities:

➣Hypokalemia

➣Hyponatremia

➣Hypochloremia

■Metabolic alkalosis (following repeated emesis):

■Metabolic acidosis (following laxative abuse)

differential diagnosis

■Anorexia nervosa, binge-eating/purging type

■Kleine-Levin syndrome

■Major depressive disorder

■Borderline personality disorder

■Body dysmorphic disorder

■Delusional disorder, somatic type

management

What to Do First

■Persuade patient that treatment is necessary

General Measures

■Referral to psychiatrist with experience in pharmacologic and behav-

ioral therapy of eating disorders