Medical complications of eating disorders in adolescents

Anorexia nervosa and bulimia are occurring with increased frequency among adolescents and preadolescents. To determine the range and severity of medical complications encountered in younger anorectic and bulimic patients, we reviewed the medical records of 65 adolescents and preadolescents, aged 10 to 20 years, who were observed in the Eating Disorders Clinic of the Children's Hospital at Stanford. Significant medical instability was present in the majority of our patients. A total of 55% of anorectic patients and 22% of bulimic patients required hospitalization for medical reasons during the study period. Cardiovascular abnormalities were frequent, including bradycardia, prolonged corrected QT intervals, dysrhythmias, and marked orthostatic pulse and BP instability. Hypothermia, with temperatures less than 35.5 degrees C, was common. Renal abnormalities included pyuria, hematuria, and proteinuria. Electrolyte derangements occurred in patients who vomited or purged. Hypokalemia was most common, but hypocalcemia, hypomagnesemia, and hypophosphatemia were also noted. The majority of our pediatric patients with eating disorders had evidence of physiologic derangement requiring medical intervention. The need for adolescents and preadolescents with eating disorders to receive ongoing medical monitoring in concert with psychiatric treatment and the need for therapists and medical practitioners to become familiar with the potential medical sequelae of eating disorders are underscored by our data.