Anorexia is a life-threatening eating disorder that has the highest mortality rate of any mental health disorder. It is characterized by extreme dietary habits such a self- induced vomiting and other forms of purging in order to prevent weight gain secondary to an abnormal perception of body shape and image. The reason why this disease is so deadly is due to the side effects and resulting complications. Almost every organ in the body is negatively affected by this disorder secondary to severe malnutrition. Malnutrition leads to electrolyte imbalances and loss of fluid in the body resulting in vital organ failure affecting the heart, kidneys, gastrointestinal tract and the brain.

Cardiovascular complications from anorexia nervosa

The heart is a muscle that pumps nutrient rich blood throughout the rest of the body. If the heart becomes weak then the rest of the organs have decreased blood flow resulting in damage. Potassium, phosphate and magnesium are extremely low in individuals with anorexia nervosa, which can result in abnormal rhythm patterns found on EKG. Common abnormal heart rhythms resulting from anorexia nervosa include supraventricular and ventricular dysrhythmias, and long QT syndrome. These arrhythmias can result in sudden death if not diagnosed and treated immediately. Additionally, low volume secondary to dehydration results in low blood pressure and a slowed heart rate, which can potential result in severe shock. Cardiomyopathy, a condition where the heart muscle weakens, and mitral valve prolapse, a valvular heart disorder are also known cardiac side effects of anorexia nervosa.

Renal complications from anorexia nervosa

The kidneys are used to filter and excrete waste and toxins from the body and when they become injured, these toxins build up in the bloodstream resulting in severe toxemia. Water and electrolytes are necessary in order for the kidneys to function immediately and when dehydration occurs, the kidneys shut down and stop working properly. Dark urine and decreased urinary output are two warning signs of kidney failure and these occur in severe cases or anorexia nervosa. Diuretics are commonly in individuals with anorexia nervosa as a means to lose water weight. These medications are usually prescribed in order to treat hypertension and heart failure and when used incorrectly in cases of anorexia nervosa as a purging mechanism, they cause severe dehydration and electrolyte disturbances resulting in direct injury to the kidneys.

Gastrointestinal complications from anorexia nervosa

Individuals who have anorexia nervosa are known to use laxatives to rid their body of any food. Self-induced vomiting is another form of purging used in individuals with anorexia nervosa. Both of these unhealthy behaviors result in direct injury to the gastrointestinal tract causing the following:

  • Decreased intestinal and gastric mobility
  • Constipation
  • Delayed gastric emptying
  • Gastric dilation and rupture
  • Esophageal tears

General complications from anorexia nervosa

Self-induced vomiting and starvation can result in severe overall body malfunctioning resulting in hormonal dysregulation and abnormal physical appearance including the following:

  • Fine body hair (lanugo)
  • Hair loss
  • Dry skin
  • Dental cavities (secondary to self-induced vomiting)
  • Delayed puberty (secondary to estrogen deficiency)
  • Stunted growth
  • Osteoporosis (secondary to estrogen deficiency)
  • Amenorrhea (loss of menstrual cycles secondary to estrogen deficiency)
  • Infertility
  • Anemia

Refeeding syndrome (RS)

Refeeding syndrome is one of the most dangerous and well-known complications from anorexia nervosa. Although the disorder itself does not result in increased mortality; the electrolyte disturbances that occur secondary to this disorder result in cardiac and renal failure potentially causing death. Refeeding syndrome occurs when the severly malnourished individual begins to increase their caloric intake either voluntarily or through a feeding tube or intravenous line. In a starvation state the body usually breaks down fats and proteins into energy because carbohydrates are depleted first in starvation. Upon increasing caloric intake through refeeding, a rise in insulin occurs due to an increase in carbohydrates resulting in a sudden shift from fat and protein metabolism to carbohydrate metabolism resulting in an extreme electrolyte imbalance. A severe decrease in phosphate, potassium and magnesium occur, formally known as hypophosphatemia, hypokalemia and hypomagnesemia. The following are additional complications, not mentioned above, that are directly related to refeeding syndrome:

  • Seizures
  • Tremors
  • Altered mental status
  • Wernicke’s encephalopathy (delirium, abnormal eye movments, gait and balance problems)
  • Korsakoff’s syndrome (anterograde and retrograde memory loss accompanied sometimes incomprehensible speech)
  • Rhabdomyolysis (muscle breakdown resulting in renal failure)
  • Respiratory depression