~bulimia or anorexia? - pindi

[ArchivalUser]

A 22-year-old woman is evaluated during a routine evaluation. She has no medical problems except for feeling tired all the time, which she attributes to working part-time while attending classes full-time and her many social activities. She denies depression, anhedonia, or constipation, and, although she has not gained weight, she has not lost any weight despite being on a diet for years. She has occasional heartburn, particularly after alcohol consumption, which she successfully self-treats two to three times per week with calcium carbonate, 500 mg. She admits to occasional binge drinking, once or twice yearly, but her CAGE score is 0/4. She smokes because it helps her to control her weight.

On physical examination, she is slightly overweight, with a BMI of 27. Her heart rate is 68/min and her blood pressure is 188/62 mm Hg. The oropharynx is remarkable for an excoriation at the back of the throat and mild bilateral parotid gland swelling. The remainder of the physical examination is normal. Complete blood count and serum thyroid-stimulating hormone level are unremarkable. Serum electrolytes are notable for mildly decreased serum potassium, slightly elevated serum bicarbonate, and mildly decreased serum chloride levels. The serum creatinine/blood urea nitrogen levels, liver chemistry tests, and urinalysis are unremarkable.

Which of the following is the most likely diagnosis?

A Bulimia nervosa
B Anorexia nervosa
C Primary aldosteronism
D Surreptitious diuretic ingestion
E Renal tubular acidosis

[ArchivalUser]

A----

[ArchivalUser]

Answer is A.

She is Bulimic.

[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

~ A..........

Several clues in this patient's history and findings suggest bulimia nervosa. She has excoriations at the back of her throat from self-induced vomiting and hypertrophy of the parotid glands. Chronic purging can lead to mild electrolyte abnormalities, including hypokalemia and slightly elevated serum bicarbonate and slightly decreased serum chloride levels. Other signs suspicious for this disorder include oropharyngeal ulcers, dental erosions, and bite marks or scars on the back of the hand.

Anorexia nervosa is another eating disorder but is not as likely as bulimia in this patient because she is slightly overweight and has maintained her normal body weight despite trying to lose weight; patients with anorexia usually have difficulty maintaining weight within 15% of an ideal body weight and often appear emaciated on physical examination. This clinical scenario does not support a diagnosis of surreptitious ingestion of diuretics or renal tubular acidosis.