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bulimia nervosa

Epidemiology: -> 3% of young women Genetics: - variations in BDNF are associated with susceptibility to bulimia nervosa 2 [4] Clinical manifestations: 1) recurrent episodes of binge eating > twice a week for 3 months 2) inappropriate compensatory methods to prevent weight gain a) self induced vomiting b) abuse of laxatives, diuretics or enemas 3) fasting, taking diet pills or thyroid medication to control weight 4) excessive exercise 5) patients are not necessarily underweight 6) patients often not forthcoming about disorder 7) signs a) tooth erosion (enamel erosion) b) gingivitis c) salivary gland (parotid gland) enlargement d) abdominal pain (gastric dilation, pancreatitis) e) diarrhea (laxative abuse) f) dehydration g) abrasions on the dorsum of the hand (associated with self-induced vomiting) 7) irregular menses [1] 8) may be some overlap with anorexia nervosa Laboratory: 1) chemistry panel a) BUN/serum creaninine may show signs of dehydration b) serum K+: hypokalemia c) serum Na+, low serum chloride (anion gap) d) serum bicarbonate: metabolic alkalosis (vomiting, diarrhea) 2) complete blood count (CBC) - anemia 3) thyroid function studies - not part of initial evaluation [6] 4) serum amylase 5) liver function tests 6) urinalysis: - elevated levels of urine sodium, urine potassium & urine chloride suggest diuretic abuse [6] - variable levels of urine sodium & urine potassium & low urine chloride suggest self-induced vomiting [6] Complications: 1) hypokalemia 2) cardiac arrhythmias 3) aspiration of gastric contents 4) gastric rupture, Mallory-Weiss tear [2] 5) increased risk of drug use [5] (RR=3.9) Differential diagnosis: - anorexia nervosa, purging subtype (BMI < 18.5) [1] - binge eating not associated with compensatory purging [1] Management: 1) cognitive behavioral therapy [1] 2) antidepressant a) regardless of whether there is comorbid depression [1] b) selective serotonin-reuptake inhibitor (SSRI) 1] often higher dose than for depression 2] fluoxetine (Prozac) a] 60 mg PO QD [3] b] lower does NOT effective c) topiramate may be beneficial [1] d) lisdexamfetamine may be of benefit [1] e) desipramine may be of benefit [3] f) do not use bupropion: increases incidence of seizures [1] 3) ondansetron [1] 4) lithium carbonate is NOT useful [3] 5) screening: SCOFF questionnaire Prognosis: more favorable than anorexia nervosa

Related

anorexia nervosa diagnostic criteria for bulimia nervosa SCOFF questionnaire

General

binge eating disorder

Database Correlations

OMIM 610269

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16, 17, 19. American College of Physicians, Philadelphia 1998, 2006, 2012, 2015, 2021. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 463
  3. Prescriber's Letter 13(8): 2006 Drug Treatment for Eating Disorders Detail-Document#: 220811 (subscription needed) http://www.prescribersletter.com
  4. OMIM :accession 610269
  5. Field AE et al Prospective Association of Common Eating Disorders and Adverse Outcomes Pediatrics. 2012 Aug;130(2):e289-95 PMID: 22802602 http://pediatrics.aappublications.org/content/early/2012/07/11/peds.2011-3663.abstract
  6. NEJM Knowledge+ Psychiatry
  7. Eating Disorders: Facts About Eating Disorders and the Search for Solutions (NIMH) http://www.nimh.nih.gov/publicat/eatingdisorders.cfm