Anorexia Nervosa

Q: 19 years old female is admitted to ICU due to severe electrolyte imbalance secondary to a long history of Anorexia Nervosa (AN). Patient tends to ________________ on exam? - select one

A) Bradycardic 

B) Tachycardic

Answer: A

Although patients with severe AN may feel frequent palpitations, on exam, they tend to be bradycardic. Severe electrolyte imbalance tends to increase the QTc to>480 msec, and subsequently leads to bradycardia. Any hemodynamic instability, particularly a heart rate less than 40 beats/minute or marked hypotension, calls for ICU admission.

Common symptoms of AN are:

• Amenorrhea (in females)
• Fatigue
• Weakness
• Cold intolerance
• Palpitations
• Dizziness
• Abdominal pain and bloating
• Early satiety
• Constipation
• Irritability or depression

Common signs are:

• Low body mass index (BMI)
• Emaciation 
• Hypothermia 
• Bradycardia 
• Hypotension 
• Hypoactive bowel sounds and distension (due to bowel edema)
• Xerosis (dry, scaly skin)
• Brittle hair and hair loss
• Lanugo hair growth
• Proximal muscle weakness
• Brittle nails
• Pressure sores
• Hypercarotenemia (especially palms)
• Cyanotic and cold hands and feet
• Generalized edema (ankle and periorbital)
• Heart murmur(possible mitral valve prolapse)

#electrolytes

#cardiology

References:

1. Eating Disorders: Core Interventions in the Treatment of and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. National Institute for Clinical Excellence, Clinical Guideline 9. http://guidance.nice.org.uk (Accessed on Jyly 22, 2025).

2. Mehler PS, Birmingham LC, Crow SJ, Jahraus JP. Medical complications of eating disorders. In: The Treatment of Eating Disorders: A Clinical Handbook, Grilo CM, Mitchell JE (Eds), The Guilford Press, New York 2010. p.66.

3. Mehler PS, Anderson AE. Eating disorders: A guide to medical care and complications, 4th ed, Johns Hopkins University Press, 2022.