Bulimia Nervosa

Prevalence ranges from 3–30% among women aged 15–30 y.

Bulimic symptoms can be part of the anorexia nervosa syndrome.

The bulimic type is more damaging than anorexia nervosa as the combination of vomiting, laxative abuse, and malnutrition can lead to global organ dysfunction.

Increased risks (which have not been quantified) of hypotension, cardiac arrhythmias, hypothermia, aspiration of gastric contents, and metabolic abnormalities and their consequences.

Reduced cardiac muscle mass with a decrease in chamber size, impaired myocardial contractility with decreased cardiac output, and relative hypotension

Mitral valve prolapse, arrhythmias, and severe bradycardia

Starvation, dehydration and electrolyte abnormalities (hyponatremia, hypokalemia, hypoalbuminemia, hypomagnesemia, hypocalcemia, hypophosphatemia)

Alterations (hypofunction) in autonomic nervous system function and a hypervagal state

Abnormal temp regulation

Decreased gastric emptying, gastric dilatation, diminished GE sphincter tone, aspiration of gastric contents, gastric rupture, and accompanying peritonitis

Compensatory hypoventilation due to chronic metabolic alkalosis from recurrent vomiting and laxative abuse

Mallory-Weiss tear or esophageal rupture leading to acute mediastinitis

Liver and kidney dysfunction

Osteoporosis and irreversible dental/gingival disease

Eating disorder characterized by binge-eating episodes followed by self-induced vomiting, fasting, and abuse of diuretics or laxatives.

Greatest periop risks are associated with low cardiac output and cardiac arrhythmias.

Hx is characterized by denial and is often unreliable. Pts may report exercise intolerance, cold intolerance, weight fluctuation, and syncope.

Unknown; thought to be largely emotional