Ver el código de «Bulimia nervosa»

==Background==
*Pattern of binging then purging with self-induced [[vomiting]] or abuse of [[laxatives]]/[[diuretics]] abuse
*Most commonly late adolescent females
*Typically normal to high BMI
*More common than anorexia

==Clinical Features==

===Diagnostic Criteria===
*A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:<ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>
**1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
**2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
*B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
*C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
*D. Self-evaluation is unduly influenced by body shape and weight.
*E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

===Signs===
*Dental enamel loss
*Scarring/erosions of dorsal fingers, hand from self-induced emesis
*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==
*[[Anorexia nervosa]], binge eating/purging type
*Binge-eating disorder
*Klein-Levin syndrome
*Major depressive disorder, with atypical features
*[[Borderline personality disorder]]
*Organic causes of [[nausea/vomiting]]

==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

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

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

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

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