Page 68 Complete Your CE Test Online - Click Here Electrocardiogram (ECG) may provide evidence of cardiac compromise by showing bradycardia, arrhythmias, and, in some cases, a significantly prolonged QT interval[1] . Metabolic disturbances Electrolyte imbalances are often evident in persons with anorexia nervosa, particularly the following disturbances[12,14] : ● ● Hypokalemia: Hypokalemia is defined as a serum potassium level below 3.5 mEq/L. Intestinal fluids contain a considerable amount of potassium. Persons with anorexia nervosa who purge by inducing vomiting and/or abusing laxatives and diuretics are at risk for hypokalemia. Signs and symptoms of this electrolyte imbalance include skeletal muscle weakness, nausea, vomiting, decreased bowel sounds, constipation, paralytic ileus, and a weak irregular pulse. The patient’s ECG may show a flattened or inverted T wave, depression of the ST segment, and a characteristic U wave. Hypokalemia may also lead to cardiac arrest. ● ● Hypochloremia: Hypochloremia is an abnormally low level of chloride in the extracellular fluid, defined as a serum chloride level below 98 mEq/L. Chloride is lost via the gastrointestinal tract via such problems as vomiting or diarrhea. Abuse of laxatives or diuretics or self-induced vomiting leads to chloride loss. Signs and symptoms of hypochloremia include muscle cramps, weakness, agitation, irritability, twitching, tetany, and hyperactive deep tendon reflexes. If the imbalance continues, it can be life threatening or even fatal. Signs of dangerously severe hypochloremia are seizures, coma, arrhythmias, and respiratory arrest. ● ● Hypomagnesemia: Hypomagnesemia, an abnormally low level of serum magnesium, occurs when the serum magnesium level falls below 1.5 mEq/L. Hypomagnesemia may occur when the body’s gastrointestinal (GI) system and/or urinary system is impaired. Both of these body systems are responsible for regulating serum magnesium levels. Hypomagnesemia can occur in persons who suffer from anorexia nervosa when excessive amounts of magnesium are lost from the GI or urinary tract due to self-induced vomiting and/or abuse of laxatives and diuretics. Signs and symptoms of hypomagnesemia are usually vague and non-specific, and include weakness, muscle cramps, tachycardia, tremor, vertigo, ataxia (lack of muscle coordination during voluntary movements), and depression. If dangerously low magnesium levels are reached, clients may experience cardiac arrhythmias, weakness of the respiratory muscles, seizures, and laryngeal stridor. Gastrointestinal problems Gastrointestinal manifestations of the disease include[12] : ● ● Delay in gastric emptying. ● ● Bloating. ● ● Constipation (can be severe). ● ● Abdominal pain. ● ● Flatulence. ● ● Diarrhea. ● ● Enlargement of salivary glands. ● ● Enlarged and inflamed pancreas. Dermatologic manifestations Manifestations of anorexia nervosa evident in the dermatologic system include[9,12] : ● ● Dry, cracked skin and loss of turgor due to dehydration. ● ● Edema. ● ● Lanugo. ● ● Acrocyanosis (bluish hands and feet). Reproductive system manifestations Anorexia nervosa can have an impact on the reproductive system, affecting ovulation and fertility. Estrogen, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels decrease. This may lead to amenorrhea, failure to ovulate, and infertility[2,9,12] . Lab studies Abnormal lab study results include[2,9,12] : ● ● Increased blood urea nitrogen (BUN). ● ● Abnormal liver function tests. ● ● Decreased albumin levels. ● ● Decreased white blood cell count (leucopenia). ● ● Decreased hematocrit and red blood cell (RBC) count leading to anemia. Neuropsychiatric problems Persons with anorexia nervosa may exhibit memory and other cognitive problems, difficulty concentrating, sleep disturbances, apathy, and abnormal taste sensations[12] . There may also be significant problems with interpersonal relationships and difficulty functioning at home, work, and/or school. The family unit may be in jeopardy as family members attempt to deal with the diagnosis of anorexia nervosa and initiate interventions to help the client ingest a proper nutrition. Research indicates that persons with anorexia nervosa often have a family history of eating disorders, and/or other mental health problems[9,12] . COMPLICATIONS OF ANOREXIA NERVOSA Some of the potentially life-threatening complications of anorexia nervosa include[1,2,9,12] : ● ● Suicide: There is a significant risk of suicide associated with anorexia nervosa. Suicide rates of 12 per 100,000 annually have been reported. Clients must be monitored for suicidal ideation and actions. It is also important that they be evaluated for co-existing mental health problems, such as major depressive disorder. ● ● Malnutrition and near-starvation: Lack of proper nutrition may lead to electrolyte imbalances, arrhythmias, and renal failure. If laxative abuse occurs, changes in the bowel can be similar to those in chronic inflammatory bowel disease. ● ● Cardiovascular compromise: Possibly fatal cardiovascular complications include a decrease in left ventricular muscle mass and heart muscle mass. Cardiac output may be reduced. ECG may show a prolonged PR interval. Heart failure and sudden death may occur, perhaps due to ventricular arrhythmias. Nursing consideration: Nurses must be alert to signs and symptoms of complications and promptly report any signs and symptoms that require prompt medical intervention. Diagnostic criteria The following statements summarize the diagnostic criteria for anorexia nervosa as identified in the DSM-5[1] : ● ● Restriction of energy intake relative to requirements. This leads to a significantly low weight for age, sex, developmental trajectory, and physical health. “Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than minimally expected.”