Hypokalemia in Patients With Eating Disorders Is Associated With Binge-Purge Behavior, Lower Body Mass Index, and Hypoalbuminemia ~Predicting Hypokalemia During Refeeding~

Abstract

Aim To identify potential mechanisms underlying hypokalemia in patients with eating disorders Background Hypokalemia is frequently found in patients with eating disorders and sometimes leads to life-threatening conditions. The mechanisms underlying hypokalemia have yet to be elucidated except for binge-purge behavior, although other factors, e.g., malnutrition and refeeding, are proposed to induce hypokalemia. In this study, we investigated factors associated with hypokalemia during acute treatment of patients with eating disorders. Methods We recruited 52 independent patients from 89 admissions with eating disorders (body mass index, 13.0 ± 3.3) and analyzed serum potassium levels at admission. Similarly, 66 admissions with > 1-week hospitalization were recruited to determine the lowest potassium levels during the refeeding period. We analyzed these levels with multiple linear regression analysis with explanatory variables, including data upon admission and treatment-related indicators. Results A lower serum potassium level at admission and a lower nadir potassium level during refeeding were associated with a lower body mass index, hypoalbuminemia, and binge-purge behavior. Similar results were obtained when the analysis included restrictive or binge-purge types as well as the independent patient group. The lowest potassium levels during the refeeding period was observed an average of 2.5 days after admission. Conclusions Thus lower body mass index, hypoalbuminemia, and binge-purge behavior might predict hypokalemia among patients with eating disorders both at admission and during refeeding. Our study is the first to demonstrate that malnutrition and refeeding themselves might induce hypokalemia among patients with eating disorders. These factors might be used as indicators to guide clinical approaches for controlling serum potassium levels during refeeding.

Medical and physiological complications of exercise for individuals with an eating disorder: A narrative review

“…Hypokalemia commonly presents in individuals with an ED engaging in purging behavior (BN or AN-P) and is prevalent in approximately 14% of individuals with BN [ 65 ]. Hypokalemia can also be triggered by malnutrition or the refeeding process [ 115 ]. Symptoms of hypokalemia may include muscle weakness, cramping, abnormal skin sensations, constipation, heart palpitations, fatigue, respiratory difficulty, and paralysis [ 65 , 116 ].…”