Generalized Weakness

A 16-year-old female presented with weakness that began about 2 weeks earlier and has become progressively worse. It was accompanied by occasional dizziness and two brief episodes of syncope. Her history was remarkable for self-induced vomiting in order to lose weight. Her obvious diagnosis was bulimia nervosa, but it was further complicated by abnormal unexplained weakness. Upon careful questioning, she admitted using ipecac to induce vomiting for the past several weeks. She was placed on a strict eating disorder protocol combined with careful cardiac monitoring and her weakness eventually resolved.