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Eating disorders are characterized by the persistent disturbance of eating impairing health or psychosocial functioning and include food restriction disorders as well as binging and purging disorders. Clinical features of restriction disorders such as anorexia nervosa include emaciation, bradycardia (Fig, 27.30), lanugo (Fig. 27.28), hair loss, and xerosis. Binging and purging disorders may present with clinical manifestations associated with frequent self-induced vomiting such as acid tooth erosion (Fig, 27.29) or Russell sign, characterized by callouses on the knuckles or back of the hand secondary to repetitive self-induced vomiting over long periods of time (Fig. 27.27).
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Management and Disposition
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Treatment of electrolyte abnormalities such as hypokalemia and hypoglycemia should be addressed on presentation. Electrocardiogram (ECG) should be obtained to evaluate for cardiac dysrhythmias. Upon ensuring medical stability, psychiatric referral should be obtained.
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Electrolyte abnormalities and cardiac dysrhythmias should be screened for in patients presenting with an eating disorder.
Psychiatric evaluation is the mainstay of long-term therapy after medical stabilization has been achieved.
Unexplained sinus bradycardia should prompt suspicion of an eating disorder.