With weight loss the heart rate slows below its normal rate of 60 to 70 beats per minute. There are sometimes dangerous changes in the electrical activity of the heart as seen on a cardiogram.
Heart affects are more dangerous if there are also abnormalities in the body chemistry, particularly low potassium. The most serious consequence is cardiac arrest.
The blood pressure is low in anorexia nervosa and this can be associated with fainting, especially with changes in posture.
Reduced fluid intake, vomiting and/or laxative misuse leads to dehydration.
It can also lead to abnormalities of the body chemistry including low sodium, low potassium and reduced levels of other elements such as calcium and magnesium.
These can, in turn, lead to dangerous abnormalities of electrical activity in the heart.
When patients are being refed with a large glucose load they can have a low phosphate and may need phosphate supplements.
With repeated vomiting, the body loses acid from the stomach making the pH of the body fluids more alkaline.
Body fluid balance can be disturbed by vomiting and laxative misuse. This can lead to an accumulation of fluid (oedema). This is often confused with “fat”.
There can be low blood glucose (hypoglycemia), abnormal glucose tolerance, low blood proteins and there can be various other vitamin and mineral deficiencies.
Most of these chemical disturbances cause weakness and lack of energy.
In Anorexia Nervosa, bones become thin due to lack of nutrients particularly calcium and vitamin D. Low estrogen levels also play a part.
If Anorexia Nervosa starts in adolescence before full stature is reached there can be a growth retardation.
The milder form of bone thinning is called osteopenia and the more severe state is osteoporosis. These conditions can lead to fractures after quite minor injuries.
Because of poor insulation when patients are underweight with Anorexia Nervosa, there is cold intolerance.
There is also poor circulation to the feet and hands which can cause a painful condition called Raynaud’s phenomenon.
Very low body temperature or hypothermia is potentially fatal. It can cause further slowing of heart rate and abnormal contractions.
Repeated vomiting can damage the teeth and produce chronic inflammation of the throat. Sometimes there is swelling of the parotid glands in the cheek. This is associated with vomiting and lengthy chewing of food.
It is possible to tear the gullet leading to bleeding and vomiting of blood.
Excessive laxative abuse can lead to loss of normal bowel muscle activity. This leads to dependence on laxatives.
There can be reduced manufacture of hemoglobin, the oxygen-carrying chemical in the red blood cells. This is anemia that causes weakness and tiredness.
Production of white blood cells is also impaired in anorexia nervosa and this will weaken the body’s defenses to infections.
The blood platelet concentrations may be low. Platelets are important in the formation of clots and in rare cases, there is the possibility of a bleeding tendency when the platelets are low.
The skin may be dry or blotchy or have an unhealthy grey or yellow coloration. Sometimes, in anorexia nervosa, excess hair grows on the face, arms and down the back. This is a fine downy hair called lanugo.
In starvation states such as Anorexia Nervosa, the ovaries and pituitary produce very low amounts of female sex hormones leading to loss of periods and infertility if not reversed. The equivalent hormone changes also occur in male patients. In Bulimia Nervosa, there is an association with multiple cysts in the ovaries.
There are also reduced levels of thyroid hormones. Blood cortisol, the stress hormone, can be high and this may contribute to thinning of the bones.
In advanced Anorexia Nervosa, there can be abnormalities in the function of all these organs.
In established anorexia nervosa there are changes in brain scans. Thinking is slowed, concentration is impaired and the focus of thinking becomes very restricted in established anorexia nervosa.
In advanced stages of Anorexia Nervosa, there can be severe muscle weakness.
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