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Objective: Diuretic abuse as a means of purging is common in patients with bulimia nervosa. We sought to illustrate the pathophysiologic effects of diuretics and purging on a patient with bulimia nervosa's fluid and electrolyte status and to clarify the role of diuretics in the management of volume status during refeeding., Method: We reviewed the literature pertaining to diuretic abuse, purging, bulimia nervosa, and diuretic therapy., Results: Purging behaviors lead to volume depletion and a state of heightened aldosterone production. Patients with bulimia nervosa commonly undergo rapid rehydration with intravenous fluid administration. In the setting of hyperaldostreronism, aggressive rehydration leads to avid salt retention and the development of marked amounts of edema., Discussion: Providers should understand both the background renal pathophysiology of the patient with bulimia nervosa and the mechanisms of action of diuretics to correctly use diuretics as focused therapeutic agents for this patient population., (Copyright © 2010 Wiley Periodicals, Inc.)

Objective: Hyponatremia is infrequently reported in the constellation of metabolic abnormalities in patients with eating disorders. We sought to identify the etiology and describe the management of a patient with anorexia nervosa and hyponatremia., Method: We report the case of a 23-year-old woman with anorexia nervosa who suffered with severe hyponatremia., Results: The etiology of hyponatremia in this case, as in most patients with eating disorders, was multifactorial, encompassing both hypovolemic and euvolemic categories of hyponatremia. Multiple impairments in the ability to clear free water are responsible for a heightened risk for hyponatremia in patients with anorexia nervosa., Discussion: This case underscores the importance of careful scrutiny of fluid intake, an awareness of medications that lead to hyponatremia, and the need for regular monitoring of serum electrolytes, even in patients with anorexia nervosa, to allow for an early diagnosis and to assist in the formulation of an effective treatment and prevention strategy., (Copyright © 2009 Wiley Periodicals, Inc.)

Objective: Hospitalized patients with severe anorexia nervosa (AN) frequently have a complex coagulation profile, with elements of hypocoagulability--thrombocytopenia and elevated international normalized ratio (INR) and elements of hypercoagulability--usually manifested as immobility, which is either due to their marked weakness or from enforced degrees of bed rest to minimize energy expenditure. Hospitalized medical patients have been shown to have appropriate prophylaxis for venous thromboembolic (VTE) disease in only 40% of cases., Method: A simple test that could evaluate the overall coagulation profile of these patients would help guide appropriate VTE prophylaxis. The thrombelastogram is a blood test that evaluates the full dynamic process of hemostasis., Results: The study of patients did not reveal evidence of being hypocoagulable and thus should be considered for VTE prophylaxis., Discussion: We report on three cases of young women with severe AN and weakness, hospitalized for closely monitored refeeding, in whom the thromboelastogram was used to evaluate the coagulation status of the patient and assist in guiding therapy., (2009 by Wiley Periodicals, Inc.)