Bulimia Nervosa Workup

Updated: Jun 06, 2016
  • Author: Gagandeep Randhawa, MBBS; Chief Editor: David Bienenfeld, MD  more...
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Laboratory Studies

See the list below:

  • Comprehensive blood chemistry panel: This is important in detecting possible occult metabolic complications of bulimia. With significant vomiting, hypokalemic metabolic alkalosis is possible. Among patients with significant laxative abuse, normokalemic metabolic acidosis may occur. Hyponatremia, hypocalcemia, hypophosphatemia, and hypomagnesemia should be ruled out. Those who have significant intravascular depletion may have elevated blood urea nitrogen levels.

  • Complete blood cell count: This is used to exclude anemia or other occult hematologic abnormalities.

  • Urinalysis: Urine specific gravity may reflect the state of hydration. Some patients may water load in an attempt to gain some weight before their health care visit.

  • Urine toxicology: Comorbid substance abuse should be ruled out with a urine toxicology screen. [61]

  • Pregnancy test: This should always be obtained to rule out pregnancy in female patients presenting with amenorrhea.

  • Amylase: Hyperamylasemia is found in up to 30% of persons with significant vomiting because of hypersecretion from the salivary glands. This may offer a rough measure of purging activity or suggest the presence of purging in patients who are suspected of purging but who deny doing it. However, serial amylase levels are not sufficiently sensitive to offer a useful clinical marker to follow the course of purging.


Imaging Studies

Imaging studies are never routinely indicated or ordered for uncomplicated or typical cases of bulimia nervosa.


Other Tests


Because of the potential for arrhythmias and cardiomyopathy as possible complications, an electrocardiogram should be performed in patients who are very thin, complaining of palpitations, or have other signs or symptoms suggestive of cardiovascular concern. Prolonged QTc, especially in the setting of hypokalemia, heighten the risk for cardiac decompensation in this population. [7]


Because of the potential for osteoporosis, a dual energy absorptiometry (DEXA) scan may be useful, particularly for patients with irregular menses, mood disorders, and/or who smoke cigarettes.


Routine neuropsychological testing is not indicated. When specific abnormalities are found in mental status testing, or when histories of learning impairment are present, neuropsychological testing may show decision-making abnormalities, as well as impairment in word recall, abstraction, attention, visuospatial functioning, and problem solving. [62, 63]