Management of physical aspects and complications of eating disorders

Eating disorders can lead to a wide range of physical complications. Some are secondary to malnutrition, whereas others are the result of purging. Patients who have an eating disorder and type 1 diabetes, and those with eating disorders in pregnancy, are at high risk. Biochemical abnormalities, such as hypokalaemia, and cardiac complications are particularly dangerous. Prolongation of the QT interval is a risk factor for ventricular arrhythmias and sudden death. QT prolongation may result from electrolyte disturbance, but also occurs in the presence of normal electrolyte levels. Drugs that prolong the QT interval should be avoided. Dental damage and oesophagitis occur in those who vomit. Micronutrient deficiencies are common in anorexia nervosa and use of a comprehensive micronutrient supplement is generally recommended. Osteoporosis and osteopenia are a significant problem in anorexia nervosa. Re-feeding can destabilize the severely malnourished patient; it should be undertaken cautiously, with careful monitoring. The early stages of re-feeding are a high-risk period for biochemical abnormalities and fluid balance problems. The complications of bulimia nervosa are generally the result of purging. A detailed physical assessment and appropriate screening investigations are important, particularly in anorexia nervosa.