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Chapter 076. Eating Disorders (Part 3)

Physical Features Patients with AN typically have few physical complaints but may note cold intolerance. Gastrointestinal motility is diminished, leading to reduced gastric emptying and constipation. Some women who develop AN after menarche report that their menses ceased before significant weight loss occurred. Weight and height should be measured to allow calculation of body mass index (BMI; kg/m2). Vital signs may reveal bradycardia, hypotension, and mild hypothermia. Soft, downy hair growth (lanugo) sometimes occurs, and alopecia may be seen. Salivary gland enlargement, which is associated with starvation as well as with binge eating and vomiting, may make the face appear. | Chapter 076. Eating Disorders Part 3 Physical Features Patients with AN typically have few physical complaints but may note cold intolerance. Gastrointestinal motility is diminished leading to reduced gastric emptying and constipation. Some women who develop AN after menarche report that their menses ceased before significant weight loss occurred. Weight and height should be measured to allow calculation of body mass index BMI kg m2 . Vital signs may reveal bradycardia hypotension and mild hypothermia. Soft downy hair growth lanugo sometimes occurs and alopecia may be seen. Salivary gland enlargement which is associated with starvation as well as with binge eating and vomiting may make the face appear surprisingly full in contrast to the marked general wasting. Acrocyanosis of the digits is common and peripheral edema can be seen in the absence of hypoalbuminemia particularly when the patient begins to regain weight. Consumption of large amounts of vegetables containing vitamin A can result in a yellow tint to the skin hypercarotenemia which is especially notable on the palms. Laboratory Abnormalities Mild normochromic normocytic anemia is frequent as is mild to moderate leukopenia with a disproportionate reduction of polymorphonuclear leukocytes. Dehydration may result in slightly increased levels of blood urea nitrogen and creatinine. Serum transaminase levels may increase especially during the early phases of refeeding. The level of serum proteins is usually normal. Blood sugar is often low and serum cholesterol may be moderately elevated. Hypokalemic alkalosis suggests self-induced vomiting or the use of diuretics. Hyponatremia is common and may result from excess fluid intake and disturbances in the secretion of antidiuretic hormone. Endocrine Abnormalities The regulation of virtually every endocrine system is altered in AN but the most striking changes occur in the reproductive system. Amenorrhea is hypothalamic in origin and reflects diminished production of