Medical Complications of Eating Disorders

Medical Complications: Cardiovascular - Heart's Heavy Toll

• Hemodynamic Changes:
  • Sinus bradycardia (often < 50 bpm, can be < 30 bpm in severe Anorexia Nervosa - AN).
  • Orthostatic hypotension.
• Structural Cardiac Changes:
  • ↓ Myocardial mass (Left Ventricular atrophy).
  • Mitral Valve Prolapse (MVP).
  • Small pericardial effusions.
• Arrhythmias & Conduction Abnormalities:
  • QTc interval prolongation (>440ms males, >460ms females): risk of Torsades de Pointes, Sudden Cardiac Death (SCD).
  • Ventricular arrhythmias.
  • SCD is a leading cause of mortality in AN.
• Electrolyte-Induced Issues (esp. Bulimia Nervosa - BN purging):
  • Hypokalemia: ECG changes (U waves, T wave flattening), arrhythmias.
  • Hypomagnesemia & hypophosphatemia exacerbate cardiac risk.
• Ipecac Toxicity (BN history):
  • Irreversible cardiomyopathy. 📌 Mnemonic: "I-Puke-Cac" -> Cardiac damage.
  • Myocardial fibrosis.
• Refeeding Syndrome Impact:
  • Rapid nutritional restoration → fluid/electrolyte shifts → cardiac overload/failure.

⭐ Bradycardia (often < 50 bpm) is the most common cardiovascular finding in Anorexia Nervosa and a key indicator of medical instability.

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Medical Complications: Metabolic/Endocrine - Imbalances Galore

• Electrolyte Disturbances (Purging is high risk):
  • Hypokalemia ($K^+$ < 3.5 mEq/L): Most common. ECG: U waves, T flattening. Risk: Arrhythmias, weakness.
  • Hypomagnesemia ($Mg^{2+}$ < 1.5 mEq/L): Often with $\downarrow K^+$. Risk: Torsades.
  • Hypophosphatemia ($PO_4^{3-}$ < 2.5 mg/dL): Key feature of refeeding syndrome; risk of cardiac/respiratory failure.
  • Hyponatremia ($Na^+$ < 135 mEq/L): Excess water intake; SIADH (rare).
  • Acid-Base: Metabolic alkalosis (vomiting $\rightarrow \downarrow Cl^-, \downarrow K^+, \uparrow HCO_3^-$), metabolic acidosis (laxatives).
• Glucose: Hypoglycemia (severe cases); impaired glucose tolerance.
• Endocrine Dysregulation:
  • HPG Axis: Amenorrhea ($\downarrow$Estrogen, $\downarrow$LH/FSH), $\downarrow$Testosterone in males.
  • HPA Axis: $\uparrow$Cortisol (Pseudo-Cushing's), Dexamethasone non-suppression.
  • Thyroid: Sick euthyroid syndrome ($\downarrow T_3, \uparrow rT_3$, normal/$\downarrow$TSH).
  • Growth Hormone: $\uparrow$GH, $\downarrow$IGF-1 (contributes to bone loss).
  • Bone Health: Osteoporosis/Osteopenia ($\downarrow$Estrogen, $\uparrow$Cortisol, $\downarrow$IGF-1).

⭐ Hypokalemia is the most life-threatening electrolyte imbalance in eating disorders, particularly with purging behaviors.

Medical Complications: GI, Derm, Hem - Body's Battle Scars

• Gastrointestinal (GI):
  • Delayed gastric emptying, gastroparesis → bloating, early satiety.
  • Constipation (common), abdominal pain.
  • GERD, esophagitis, dental erosion (perimylolysis from vomiting).
  • Mallory-Weiss tears (esophageal tears from vomiting).
  • Sialadenosis (parotid gland enlargement).
  • Superior Mesenteric Artery (SMA) syndrome: weight loss → duodenal compression.
  • Elevated liver enzymes; Melanosis coli (laxative abuse).
• Dermatological (Derm):
  • Lanugo (fine, downy body hair).
  • Xerosis (dry skin), telogen effluvium (hair loss).
  • Brittle nails, acrocyanosis (cold, blue extremities).
  • Carotenemia (yellowish skin, spares sclera).
  • 📌 Russell's sign: knuckle calluses/abrasions (self-induced vomiting).
  • Petechiae, purpura (impaired clotting).
• Hematological (Hem):
  • Anemia (normocytic → microcytic/macrocytic from deficiencies).
  • Leukopenia, neutropenia (↑infection risk).
  • Thrombocytopenia (↓platelets).
  • Pancytopenia (severe starvation; bone marrow suppression).

⭐ Superior Mesenteric Artery (SMA) syndrome: significant weight loss reduces aortomesenteric fat pad, compressing duodenum between aorta & SMA, causing obstructive symptoms.

High-Yield Points - ⚡ Biggest Takeaways

• Anorexia Nervosa (AN): Risks include bradycardia, hypotension, osteoporosis, amenorrhea, and refeeding syndrome (key: hypophosphatemia).
• Bulimia Nervosa (BN): Presents with Russell's sign, dental erosion, parotid swelling, and electrolyte imbalances (e.g., hypokalemia).
• Hypokalemia: Critical in AN/BN, causes cardiac arrhythmias.
• Cardiac Issues: Leading cause of death in AN (e.g., arrhythmias, cardiomyopathy).
• Osteoporosis: Severe in AN from low estrogen and malnutrition.
• Refeeding Syndrome: Fatal electrolyte shifts (monitor phosphate) during re-nutrition of severely malnourished patients.