Electrolyte and acid‐base abnormalities associated with purging behaviors

Mehler, Philip S.; Walsh, Kristine

doi:10.1002/eat.22503

Cited by 33 publications

(43 citation statements)

References 77 publications

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“…2 Recurrent hypokalemia is a dangerous complication in eating disorders with purge-type behaviour, and is a contributor to hospital admissions, cardiac complications, and mortality. 3,4 Our patient had a pattern of recurrent admissions for symptomatic hypokalemia despite ongoing home use of oral potassium supplements. Based on her history and persistent vomiting, a recurrence of hypokalemia following hospital discharge was likely.…”

Section: Discussionmentioning

confidence: 90%

Proton Pump Inhibition in the Management of Hypokalemia in Anorexia Nervosa with Self-Induced Vomiting

Azim

Neary

2018

Can Journ Gen Int Med

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Hypokalaemia is a dangerous complication in severe cases of eating disorders with self-induced vomiting and can result in rhabdomyolysis, cardiac arrhythmias, and death. Self-induced vomiting leads to hypokalaemia through two pathways. First, loss of gastric acid causes hypochloraemic metabolic alkalosis, which increases filtered bicarbonate load in the nephron (exceeding the tubular resorptive threshold), and subsequently increases distal sodium bicarbonate delivery. Secondly, hypovolaemia causes activation of the renin-angiotensin-aldosterone axis. Increased distal sodium delivery and mineralocorticoid activity together cause urinary potassium wasting. Standard management of severe hypokalaemia in patients with anorexia or bulimia nervosa and persistent self-induced vomiting includes intravenous replacement of potassium and correction of hypovolaemia. However, hypokalaemia is often refractory in eating disorder outpatients who have ongoing self-induced vomiting after discharge. We present a case of hypokalaemia due to anorexia nervosa, binge-purge subtype with self-induced vomiting successfully treated with a proton pump inhibitor (PPI) in addition to standard therapy.

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Section: Discussionmentioning

confidence: 90%

Proton Pump Inhibition in the Management of Hypokalemia in Anorexia Nervosa with Self-Induced Vomiting

Azim

Neary

2018

Can Journ Gen Int Med

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“…Since hypokalemia is a well-known consequence of purging, (Mehler & Walsh, 2016) we expected to find a higher frequency of hypokalemia in patients with BN, particularly among those who purge.…”

Section: Discussionmentioning

confidence: 96%

“…Since hypokalemia is a well‐known consequence of purging, (Mehler & Walsh, ) we expected to find a higher frequency of hypokalemia in patients with BN, particularly among those who purge. Moreover, we expected that potassium derangements in purging patients with BN would be associated with an increased risk of a prolonged QTc (Marill & Miller, ).…”

Section: Discussionmentioning

confidence: 98%

The QTc interval and risk of cardiac events in bulimia nervosa: A long‐term follow‐up study

Frederiksen

Christiansen

Østergaard

et al. 2018

Intl J Eating Disorders

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Objective An association between bulimia nervosa (BN) and prolonged corrected QT interval (QTc) in the electrocardiogram has been suggested, but results of previous studies are conflicting, and the risk of cardiac events in patients with BN has yet to be investigated. Method We estimated mean QTc interval and relative risk of borderline (QTc >440 ms) and prolonged QTc (QTc >460 ms) between adult women with BN (N = 531) and healthy controls (N = 123). In follow‐up analyses, we investigated the risk of a primary endpoint (syncope, ventricular tachycardia, and cardiac arrest) and all‐cause mortality in patients with BN (N = 702) compared with a population‐based cohort derived from the Danish Civil Register (N = 7,020). Results Mean QTc did not differ between patients with BN and controls. Relative risk of borderline prolonged QTc was 2.3 (p = 0.28). The number of patients and controls with prolonged QTc was small, and the risk did not differ between patients with BN and controls. Median follow‐up was 10.6 years. Although there appeared to be increased risks after 5 years of follow‐up, long‐term risks of the primary endpoint (Hazard ratio [HR] = 1.4, p = 0.37) and all‐cause mortality (HR = 1.7, p = .28), respectively, were not increased in patients with BN compared to a population‐based cohort. Discussion Mean QTc did not differ between patients with BN and healthy controls, and the risk of prolonged QTc was not increased in patients with BN. There was no difference in the long‐term risk of cardiac events, and long‐term all‐cause mortality did not differ significantly between patients with BN and a population‐based cohort.

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“…If untreated and persistent, these two types of eating disorders result in electrolyte and acid-base disturbances, affecting serum and urine sodium, potassium, and chloride, and serum bicarbonate and pH [3]. Common electrolyte disturbances include hypokalemia and hyponatremia [4].…”

Section: Electrolyte Disturbancesmentioning

confidence: 99%

Hyponatremia and Psychiatric Diseases

Bojdani¹,

Souza²,

Rajagopalan³

et al. 2020

Weight Management

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Eating disorders, psychotic illnesses, and substance use disorders are some of the more common psychiatric conditions encountered in clinical practice that are associated with hyponatremia. The mechanisms that lead to hyponatremia vary, and at times hyponatremia may be a result of a drug side effect or drug-drug interaction. Additionally, hyponatremia from a non-psychiatric condition may lead to psychiatric symptomatology. Given the potential for hyponatremia to cause significant morbidity and potential mortality, clinicians are urged to consider screening for plasma sodium in patients at risk of hyponatremia, such as patients in the three categories of psychiatric conditions described above. Treatment of hyponatremia consists of various acute interventions, with consideration that treatment of the underlying psychiatric condition may help to diminish or eliminate the frequency of hyponatremic episodes in the long run.

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Electrolyte and acid‐base abnormalities associated with purging behaviors

Cited by 33 publications

References 77 publications

Proton Pump Inhibition in the Management of Hypokalemia in Anorexia Nervosa with Self-Induced Vomiting

Proton Pump Inhibition in the Management of Hypokalemia in Anorexia Nervosa with Self-Induced Vomiting

The QTc interval and risk of cardiac events in bulimia nervosa: A long‐term follow‐up study

Hyponatremia and Psychiatric Diseases

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