Management of physical aspects and complications of eating disorders

Patients with anorexia nervosa are at risk of a range of complications, some of which are potentially life-threatening. Some complications are secondary to malnutrition, while others are the result of purging. Hypokalaemia is common in those who vomit or abuse laxatives; oral supplements may be required. Bone marrow suppression occurs. Delayed gastric emptying, constipation and symptoms of the irritable bowel syndrome are common. Sinus bradycardia and hypotension do not usually require treatment. Osteoporosis occurs in up to 40% of patients. Weight restoration increases new bone formation but it is unclear whether complete recovery of bone density is possible. The treatment of osteoporosis is uncertain and evidence for the effectiveness of oestrogen supplementation is equivocal. Amenorrhoea normally resolves on weight restoration. Anorexic women who become pregnant are at risk of premature delivery and the perinatal mortality rate is increased. Refeeding should be undertaken cautiously as there is a risk of electrolyte and fluid balance disturbances; severe hypophosphataemia may occur. The use of a micronutrient supplement is recommended during refeeding. Refeeding oedema should be distinguished form cardiac failure. Patients with eating disorders should undergo a detailed physical and laboratory assessment. Close monitoring is essential during refeeding.