PsychEd Shorts 17: Medical Considerations in Eating Disorders

Let's go through the medical complications one body system at a time, starting with the heart.

In prolonged starvation, the body breaks down protein for fuel, and cardiac muscle isn't spared from this, so the heart itself will shrink.

The most common finding is sinus bradycardia.

It's usually an adaptation to lower metabolic demand and a higher vagal tone rather than primary heart disease, but adaptive doesn't mean that this is safe.

Hypotension and orthostatic changes often come with this.

Mitral valve prolapse has also been described, likely because the ventricle shrinks while the valve tissue doesn't.

and a small silent pericardial fusion is also common.

In severe cases, the atrophied heart is also what makes refeeding risky if fluid and nutrition are introduced too quickly.

The impact on electrolytes in metabolism depends on the type of disordered eating behavior.

In starvation, you can expect hypoglycemia from depleted glycogen stores, mildly elevated liver enzymes, and delayed gastric emptying with nausea, bloating, constipation, and postprandial fullness.

These symptoms can make refeeding physically uncomfortable and reinforce the restricting behavior.

Self-induced vomiting causes the loss of hydrogen and chloride from the stomach.

This leads to a hypochromic-hypochloremic metabolic alkalosis.

Laxative misuse tends to cause volume depletion along with the opposite kind of acid-based picture, where bicarbonate loss causes a metabolic acidosis, although other electrolyte and acid-based arrangements are also possible.