Metabolic Disturbances Electrolyte imbalances are often evident in persons with anorexia nervosa, particularly the following disturbances (Mayo Clinic, 2018e; Videbeck, 2017; Willis, 2015): ● Hypokalemia: Hypokalemia is defined as a serum potassium level below 3.5 mEq/L. Intestinal fluids contain a considerable amount of potassium. Persons with anorexia nervosa who purge by inducing vomiting or abusing laxatives and diuretics are at risk for hypokalemia. Signs and symptoms of this electrolyte imbalance are skeletal muscle weakness, nausea, vomiting, decreased bowel sounds, constipation, paralytic ileus, and a weak irregular pulse. The patient’s ECG may show a flattened or inverted T wave, depression of the ST segment, and a characteristic U wave. Hypokalemia can also lead to cardiac arrest. ● Hypochloremia: Hypochloremia is an abnormally low level of chloride in the extracellular fluid, defined as a serum chloride level below 98 mEq/L. Chloride is lost via the gastrointestinal tract via such problems as vomiting and diarrhea. Abuse of laxatives or diuretics or self-induced vomiting leads to chloride loss. Signs and symptoms of hypochloremia are muscle cramps, weakness, agitation, irritability, twitching, tetany, and hyperactive deep tendon reflexes. If the imbalance continues, it can be life-threatening or even fatal. Signs of dangerously severe hypochloremia are seizures, coma, arrhythmias, and respiratory arrest. ● Hypomagnesemia: Hypomagnesemia, an abnormally low level of serum magnesium, occurs when the serum magnesium level falls below 1.5 mEq/L. Hypomagnesemia can occur when the body’s gastrointestinal (GI) system or urinary system is impaired. Both of these body systems are responsible for regulating serum magnesium levels. Hypomagnesemia can occur in persons who suffer from anorexia nervosa when excessive amounts of magnesium are lost from the GI or urinary tract because of self- induced vomiting or abuse of laxatives and diuretics. Signs and symptoms of hypomagnesemia are usually vague and nonspecific and include weakness, muscle cramps, tachycardia, tremor, vertigo, ataxia (lack of muscle coordination during voluntary movements), and depression. If dangerously low magnesium levels are reached, clients could experience cardiac arrhythmias, weakness of the respiratory muscles, seizures, and laryngeal stridor. ● Hypocalcemia: Hypocalcemia occurs when an individual does not have an adequate calcium intake, when the body does not properly absorb the mineral, or when excessive amounts of calcium are lost from the body. In hypocalcemia, the total serum calcium level is less than 8.9 mg/dl. Other complications are fractures; brittle nails; dry skin and hair; hyperactive tendon reflexes; hypotension; diminished response to drugs such as digoxin, dopamine, and norepinephrine; decreased cardiac output; prolong ST segment and prolonged QT interval on ECG; and decreased myocardial contractility. ● Hyponatremia: Hyponatremia occurs when plasma sodium concentration is lower than 135 mEq/L. Signs and symptoms of hyponatremia are nausea, vomiting, headache, confusion, loss of energy, drowsiness and fatigue, muscle weakness, spasms, cramps, seizures, and coma. Gastrointestinal Problems Clients with eating disorders often complain of gastrointestinal (GI) symptoms, which are often a consequence of the eating disorder rather than a separate pathology. However, early in the disease course, GI complaints may preoccupy the clients and their physicians to the extent that they interfere with psychological treatment essential to the treatment of eating disorders (Mehler, 2017b).
Gastrointestinal manifestations of the disease include the following (Mehler, 2017b; Videbeck, 2017): ● Delay in gastric emptying ● Bloating ● Constipation (can be severe) ● Abdominal pain ● Flatulence ● Diarrhea These are manifestations of anorexia nervosa evident in the dermatologic system (Gersch et al., 2016; Videbeck, 2017): ● Dry, cracked skin and loss of turgor from dehydration ● Edema ● Lanugo (soft, fine hair over the face and body) Anorexia nervosa can impact the reproductive system by affecting ovulation and fertility. Estrogen, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels decrease. This can lead to amenorrhea, failure to ovulate, and infertility (Gersch et al., 2016; Videbeck, 2017). Lab Studies Here are abnormal lab study results (Gersch et al., 2016; Videbeck, 2017): ● Increased blood urea nitrogen (BUN) ● Abnormal liver function tests ● Decreased albumin levels ● Leukopenia (decreased white blood cell count) ● Decreased platelets ● Decreased hematocrit and red blood cell (RBC) count leading to anemia ● Decreased T3 level ● Ketonuria, low urine specific gravity ● Serum chemistry studies: metabolic acidosis, decreased potassium, magnesium, sodium, phosphorous, and glucose Other tests that should be considered in women are bone densitometry and estradiol. Women with eating disorders, especially anorexia nervosa, are at high risk for osteoporosis. Research has shown that 75% of women who meet the criteria for anorexia nervosa show some evidence of bone mineral deficiency (Eating Disorder Hope, 2018c). ● Enlargement of salivary glands ● Enlarged and inflamed pancreas Dermatologic Manifestations ● Acrocyanosis (bluish hands and feet) Reproductive System Manifestations Levels of estradiol, a major estrogen, should also be evaluated in terms of replacement therapy. Research has suggested that estrogen therapy may help to decrease risk for osteoporosis as well as decrease some of the psychopathology associated with eating disorders (U. S. National Library of Medicine, ClinicalTrials. gov, 2019). Neuropsychiatric Problems Persons with anorexia nervosa may exhibit memory and other cognitive problems, difficulty concentrating, sleep disturbances, apathy, and abnormal taste sensations (Gersch et al., 2016; Videbeck, 2017). There may also be significant problems with interpersonal relationships and difficulty functioning at home, work, or school. The family unit may be in jeopardy as family members attempt to deal with the diagnosis of anorexia nervosa and initiate interventions to help the client ingest proper nutrition. Research has shown that persons with anorexia nervosa often have a family history of eating disorders or other mental health problems (Gersch et al., 2016; Videbeck, 2017).
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