Eating disorders – includes obesity, anorexia, bulimia
Difference between anorexia and bulimia?
Distorted body image; women with anorexia can have distorted image; control issue; they have
lost control of everything in their life, and the only thing that they can control over is what they
put in their mouth. With a decrease of body fat and wt, GnRH decreases, therefore FSH and LH
also decrease, leading to low estrogen; as a result, amenorrhea occurs, AND predisposes to
osteoporosis, as if pt is postmenopausal. Anorexic people will eventually develop osteoporosis.
Rx – convince person to gain enough wt to bring period back; not birth control.
(ie first step in management of HP/diabetes = wt loss; as you lose adipose, you upregulate
insulin resistance). In anorexia, usually die to cardiac dz (heart failure: heart just stops).
1. Metabolic Alkalosis: It’s not a body image problem – they can be obese, normal or thin (no
weight issue); however, they binge (eat a lot), then force themselves to vomit. Pic on boards:
from vomiting, wear down enamel on teeth; so, brownish stuff seen on teeth is just dentine
(erosions seen on teeth). Metabolic alkalosis from forced vomiting will be seen. Metabolic
alkalois is bad b.c there is a left shift curve, and the compensation is resp acidosis, which drops
pO 2 therefore will get hypoxia with metabolic alkalosis, and the heart do not like that. The
heart already with low O w2ll get PVC’s (pre-mature ventricular contractions), RRT phenom,
then V-fib, then death. Therefore, met alkalosis is very dangerous in inducing cardiac
arrythmias, and this commonly occurs in bulimics due to forced vomiting. Pt can also vomit out
blood – Mallory Weiss Syndrome – tear in distal esophagus or proximal stomach.