Physical assessment of patients with anorexia nervosa and bulimia nervosa: an international comparison

Abstract

Objective: A questionnaire study was carried out to determine which investigations were carried out routinely on patients with anorexia nervosa and bulimia nervosa. Method: A specially designed questionnaire was sent to 168 clinicians working in the field of eating disorders in 25 countries. Respondents were asked to supply information about how often they carry out specific investigations on new patients with AN and BN. The questionnaire covered the use of physical examination, biochemical and haematological tests and cardiac investigations. Results: 71 (42.3 per cent) questionnaires were returned. Biochemical investigations and full blood counts were carried out frequently. Significant differences were found between AN patients and BN patients in the measurement of calcium, phosphate and magnesium levels. In some cases, patients with BN were not routinely assessed for hypokalaemia. Micronutrient levels were measured rarely and only 40 per cent of respondents carried out routine electrocardiograms (ECGs) in AN. Discussion: Measurement of serum potassium should be routine in BN and other electrolytes should probably measured more often in both disorders. Detection of treatable micronutrient deficiencies should be given more emphasis and the ECG should become a routine investigation in AN.

Screening for osteoporosis in anorexia nervosa: Prevalence and predictors of reduced bone mineral density

“…1 This study was designed to establish the prevalence of osteopenia and osteoporosis in an unselected clinical population and to identify predictors of reduced BMD. BMD is expressed as a T-score, which is equivalent to one standard deviation (SD) above or below the mean for a young adult.…”

Bioelements and eating disorders - aspects of the quality of live

“…Electrolyte abnormalities often occur in the disorder and are a risk factor leading to ventricular arrhythmia and sudden death (COOKE, CHAMBERS 1995, DUBELT, SZEWCZYK 2007. Other reported biochemical abnormalities involve increase in hepatic enzymes and loss of thiamin and zinc (KOVACS, WINSTON 2003). Hypoalbuminemia was proved to be the most valid biochemical marker of the risk of life loss in anorexia (HERZOG et al 1997).…”

“…Hypoalbuminemia was proved to be the most valid biochemical marker of the risk of life loss in anorexia (HERZOG et al 1997). Endocrinological abnormalities in anorexia involve decreased gonadotrophin secretion, hypocortisolemia and sick euthyroid syndrome (euthyroid is a state of normal thyroid function) (KOVACS, WINSTON 2003). Moreover, hyperthyroidism and Addison disease are important differential diagnosis in this disorder.…”

“…Moreover, hyperthyroidism and Addison disease are important differential diagnosis in this disorder. The patients with serious eating disorders should be fully diagnosed clinically and via laboratory tests as part of the initial assessment (MITCHELL, SPECKER, DE ZWANA 1991, KOVACS, WINSTON 2003. Late complications of the disorder involve decrease of mineral bone density (osteopenia and osteoporosis), tissue composition disturbances and structural (atrophy) and functional changes in the central nervous system (RABE-JAB£OÑSKA, MELCER 2006).…”

“…The biochemical disturbances described above have an unqeustionably very significant meaning for the patients' life quality, therefore the research conducted by KOVACS and WINSTON (2003) is very interesting. The authors assessed which diagnostic method of for electrolytic disturbances in people with eating disorders is the most suitable.…”