Review articleMedical complications of eating disorders: an update
Section snippets
Cardiac complications of eating disorders
Starvation can result in wasted cardiac muscle, sinus bradycardia, hypotension, and reduced left ventricular mass, associated with systolic dysfunction [5]. At a microscopic level, myofibrillar atrophy and destruction may result in decreased contractile force and cardiac output [6]. Patients with AN may complain of marked fatigue and have an attenuated blood pressure response to exercise with a reduction in maximal work capacity 7, 8. One-third may have mitral valve prolapse, from wasted
Refeeding syndrome
The risk for cardiac decompensation is highest during the initial stages of refeeding, when left ventricular mass and contractility are already compromised by chronic starvation in patients with AN. “Refeeding syndrome” refers to cardiovascular collapse and possible death that follows oral or parenteral intake of highly caloric nutrients, especially those high in glucose [6]. Delirium can occur during, or after, the second week of refeeding and may continue for several weeks 14, 18, 19. The
Renal abnormalities
Transient azotemia, decreased glomerular filtration rate, decreased concentrating ability, short periods of acute renal failure, and, more rarely, chronic renal failure have been noted in patients with eating disorders 23, 24, 25. Those patients experiencing higher percentages of weight reduction and low body mass index may be at risk for borderline decreases in renal function even with normal levels of serum creatinine [26]. Four adult patients (aged from 31 to 43 years) developed end stage
Water intoxication
Many patients with AN “water load,” either to blunt appetite by creating a sensation of fullness, to falsely elevate weight for medical visits, or in the misguided belief that consumption of water will purify the body and eliminate “toxins” and calories through the urine 25, 26. Water intoxication can cause severe hyponatremia and hypo-osmolality, which can produce cerebral edema, leading to ataxia, seizures, coma, and death 29, 30. As with many of the self-destructive behaviors of eating
Gastrointestinal and oropharyngeal effects
Gastrointestinal (GI) effects of starvation include: delayed gastric emptying, slowed gastrointestinal motility, abnormal esophageal motor activity, and abnormal hormonal and neurotransmitter functions 31, 32, 33, 34, 35, 36, 37. Prokinetic drugs such as cisapride or metochlopromide may relieve some of gastrointestinal symptoms, although the former is not currently used in the United States [38]. Gastrointestinal symptoms may persist after recovery from eating disorders [39], although they tend
Amenorrhea, osteopenia, and eating disorders: the Female Athlete Triad
The Female Athlete Triad refers to the inter-relatedness of amenorrhea, osteopenia, and disordered eating. Athletes with a healthy body image and no evidence of disordered eating may still have athletic amenorrhea. Athletic amenorrhea tends to occur most frequently in females who combine intense physical training with a low stable caloric intake working toward a desired lean body build, as is idealized in gymnastics, ballet, endurance running, or figure skating [47]. In the athletic female with
Hematologic effects
Pancytopenia can be seen in patients with eating disorders. In one study, a relative leukopenia occurred in 23% of patients who were in a state of starvation, caused primarily by increased margination of the white blood cells 21, 73. Accordingly, patients do not have increased susceptibility to infection. Anemia is less common than leukopenia owing to the high prevalence of amenorrhea; however, a microcytic anemia can be seen in vegetarian patients, and hemoglobin levels may be falsely elevated
Effects on the brain
Recent research has focused on the cerebral atrophy and loss of brain volume that accompanies AN 74, 75. In protracted cases of individuals with AN in a state of prolonged malnutrition, enlargement of the cortical sulci and cisterns, ventricular dilatation, and pituitary gland atrophy can occur [76]; these findings may, or may not, be reversible with recovery 75, 76, 78, 79. Some patients may have concomitant cerebral and cerebellar atrophy [80]. Hypothesized mechanisms to explain these
Other medical findings
Acquired pili torti, a structural hair defect that means “twisted hair,” has been seen in patients with AN [84]. This finding may be associated with malnutrition combined with excess intake of yellow vegetables and vitamins. Increased levels of serum carotene, retinyl esters, retinol, and retinoic acid were found in a series of 14 patients who demonstrated pili torti. Other dermatologic findings associated with starvation include alopecia, xerosis, hypertrichosis, and nail fragility [85].
An
Conclusion
The medical complications of eating disorders are significant and potentially irreversible and life-threatening. Moreover, careful explanation of the medical changes that occur when a patient has an eating disorder may help patients make positive changes. Further research is needed to clarify the role of hormone replacement therapy and the use of the bisphosphonates, DHEA, and other newer drugs to treat osteopenia in patients with eating disorders[77].
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