Hostname: page-component-594f858ff7-x2rdm Total loading time: 0 Render date: 2023-06-09T22:10:42.945Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "corePageComponentUseShareaholicInsteadOfAddThis": true, "coreDisableSocialShare": false, "useRatesEcommerce": true } hasContentIssue false

Electrolyte and other physiological abnormalities in patients with bulimia

Published online by Cambridge University Press:  09 July 2009

James E. Mitchell*
Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
Richard L. Pyle
Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
Elke D. Eckert
Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
Dorothy Hatsukami
Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
Richard Lentz
Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
1Address for correspondence: Dr James Mitchell, Box 393 Mayo, University Hospitals, Minneapolis, MN 55455, USA.


The frequencies of various forms of eating-related behaviour (such as vomiting and laxative abuse) are reported for a series of non-anorectic bulimia patients seen for evaluation in an eating disorders clinic. The results of serum electrolyte, glucose and other screening tests in these patients are presented. Electrolyte abnormalities were found in 82 of the 168 patients (48·8%) who were diagnosed as having either bulimia or atypical eating disorder. The most common abnormality was metabolic alkalosis (27·4%); hypochloremia (23·8%) and hypokalemia (13·7%) were also commonly seen. No significant blood sugar abnormalities were encountered. An elevated serum amylase level was found to be associated with frequent binge-eating and vomiting behaviour. The pathophysiology of electrolyte abnormalities in this patient group is briefly reviewed.

Research Article
Copyright © Cambridge University Press 1983

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)



American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (third edition) pp. 6971. APA: Washington, D.C.Google Scholar
Casper, R. C., Eckert, E. D., Halmi, K. A., Goldberg, S. C. & Davis, J. M. (1980). Bulimia: its incidence and clinical importance in patients with anorexia nervosa. Archives of General Psychiatry 37, 10301035.CrossRefGoogle ScholarPubMed
Cogan, M. G., Rector, F. C. & Seldin, D. W. (1981). Acid–base disorders. In The Kidney (ed. Brennar, B. and Rector, F.), pp. 841907. W. B. Saunders: Philadelphia.Google Scholar
Elkinton, J. R. & Huth, E. J. (1958). Body fluid abnormalities in anorexia nervosa and undernutrition. Metabolism 8, 376403.Google Scholar
Gabow, P. (1976). Disorders of potassium metabolism. In Renal and Electrolyte Disorders (ed. Schrier, R.), pp. 143165. Little, Brown: Boston.Google Scholar
Halmi, K. A. & Falk, J. R. (1981). Common physiological changes in anorexia nervosa. International Journal of Eating Disorders 1, 1643.3.0.CO;2-H>CrossRefGoogle Scholar
Halmi, K. A., Falk, J. R. & Schwartz, E. (1981). Binge-eating and vomiting: a survey of a college population. Psychological Medicine 11, 697706.CrossRefGoogle ScholarPubMed
Hawkins, R. C. & Clement, P. F. (1980). Development and construct validation of a self-report measure of binge eating tendencies. Addictive Behaviors 5, 219266.CrossRefGoogle ScholarPubMed
Hill, O. W. (1968). Psychogenic vomiting. Gut 9, 348352.CrossRefGoogle ScholarPubMed
Kaehny, W. O. (1976). Pathogenesis and management of metabolic acidosis and alkalosis. In Renal and Electrolyte Disorders (ed. Schrier, R.), pp. 79120. Little, Brown: Boston.Google Scholar
Levin, P. A., Falk, J. M. & Dixon, K. (1980). Benign parotid gland enlargement in bulimia. Annals of Internal Medicine 93, 827829.CrossRefGoogle ScholarPubMed
Mitchell, J. E. & Pyle, R. A. (1982). The bulimia syndrome in normal weight individuals: a review. International Journal of Eating Disorders 1, 6173.3.0.CO;2-T>CrossRefGoogle Scholar
Mudge, G. H. (1980). Agents affecting volume and composition of body fluids. In The Pharmacological Basis of Therapeutics (ed. Gilman, A. G., Goodman, L. S. and Gilman, A.), pp. 848884. Macmillan: New York.Google Scholar
Oster, J. R., Materson, B. J. & Rogers, A. I. (1980). Laxative abuse syndrome. American Journal of Gastroenterology 74, 451458.Google ScholarPubMed
Pyle, R. L., Mitchell, J. E. & Eckert, E. D. (1981). Bulimia: a report of 34 cases. Journal of Clinical Psychiatry 42, 6064.Google ScholarPubMed
Russell, G. (1979). Bulimia nervosa: an ominous variant of anorexia nervosa. Psychological Medicine 9, 429448.CrossRefGoogle ScholarPubMed
Schrier, R. W. (1976). Renal sodium excretion, edematous disorders, and diuretic use. In Renal and Electrolyte Disorders (ed. Schrier, R.), pp. 4577. Little, Brown: Boston.Google Scholar
Stunkard, A. J. (1959). Eating patterns and obesity. Psychiatric Quarterly 33, 284295.CrossRefGoogle ScholarPubMed
Sunderman, F. W. & Rose, E. (1948). Studies in serum electrolytes. XVI. Changes in the serum and body fluids in anorexia nervosa. Journal of Clinical Endocrinology and Metabolism 8, 209220.CrossRefGoogle Scholar
Wallace, M., Richards, P., Chesser, E. & Wrong, O. (1968). Persistent alkalosis and hypokalemia caused by surreptitious vomiting. Quarterly Journal of Medicine 37, 577588.Google ScholarPubMed
Warren, M. P. & Vande, Wiele R. L. (1973). Clinical and metabolic features of anorexia nervosa. American Journal of Obstetrics and Gynecology 117, 435449.CrossRefGoogle ScholarPubMed
Warren, S. E. & Steinberg, S. M. (1979). Acid–base and electrolyte disturbances in anorexia nervosa. American Journal of Psychiatry 136, 415418.Google ScholarPubMed
Webb, W. L. & Gehi, M. (1981). Electrolyte and fluid imbalance: neuropsychiatric manifestations. Psychosomatics 22, 199202.CrossRefGoogle ScholarPubMed
Wolff, H. P., Kruck, F., Brown, J. J., Lever, A. F., Vecsei, P., Roscher, S., Dusterdieck, G. O. & Robertson, J. I. S. (1968). Psychiatric disturbance leading to potassium depletion, sodium depletion, raised plasma-renin concentration, and secondary hyperaldosteronism. Lancel i, 257261.CrossRefGoogle Scholar