Eating disorders: anorexia nervosa, bulimia nervosa. Malnutrition, vitamin deficiencies

1. Big picture

This topic connects psychiatry + internal medicine + nutrition + emergency medicine. In the exam, do not present anorexia and bulimia only as “psychological problems.” They are eating disorders with potentially severe cardiovascular, electrolyte, endocrine, gastrointestinal, hematological, skeletal, and neurological complications.

The examiner wants you to recognize:

Weight loss / binge–purge behavior
        ↓
malnutrition or electrolyte disturbance
        ↓
bradycardia, hypotension, hypokalemia, arrhythmia, amenorrhea, osteoporosis
        ↓
risk of sudden death and refeeding syndrome

NICE emphasizes early assessment and treatment of eating disorders, especially in patients with or at risk of severe emaciation, and recommends immediate referral to an age-appropriate eating disorder service when an eating disorder is suspected. ([NICE][1])