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Primarily in white adolescent females from middle- or upper-class families; 4% to 10% males.
More common in models, ballet students, and professions demanding high achievement.
Occurs in 5-10 per 100,000 population; mortality rate 5-10%.
Bimodal peak age of onset: 14 and 18 y.
Predisposing conditions include:
CV dysfunction (bradycardia, hypotension, and dysrhythmias).
Acid-base abnormalities (both metabolic acidosis and alkalosis are possible), lyte abnormalities (decreased K, Mg, NA, and P)
Hematologic abnormalities (decreased Hgb, WBC, fibrinogen, and plt).
Hypothermia, delayed gastric emptying, and renal dysfunction (prerenal azotemia).
Lyte/nutrient abnormalities associated with refeeding: most dangerous is hypophosphatasia (but also thiamine deficiency and decreased K. Mg, NA, and P).
Degree and duration of malnutrition (excess protein depletion = impaired cellular function)
Degree of organ dysfunction
Greater weight loss = greater risk
Refeeding syndrome (severe hypophosphatasia occurred in 0.5% in largest modern study)
Anorexia nervosa
Obsessive fear of obesity; pursuit of thinness
Dramatic decrease in food intake and excessive physical activity
Refusal to maintain weight above 85% IBW
Distorted body image
Amenorrhea for >3 mo
Radical restriction of caloric intake
Appears cachectic
Risk of death high if weight loss >40% of IBW
Of patients, 40% to 50% recover with treatment; 20% to 30% improve with treatment
Bulimia
Means “ox hunger” or voracious appetite
Obsessive fear of obesity; overconcern with body shape and weight
Appears well nourished
Averages two binge-eating episodes each wk for at least 3 mo
Irresistible urge to overeat; loss of control in desire to eat
Wt control by self-induced vomiting, diuretic and laxative use, strict dieting/fasting, vigorous exercise
Greater percent of alcohol use, illicit drug use, stealing, self-mutilation, and suicide attempts than with anorexia
Of patients, 30% to 60% recover with treatment
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