Laboratory Studies

Bulimia nervosa (BN) requires a clinical diagnosis. No single laboratory test can be diagnostic. The laboratory tests listed below may be helpful in assessing the medical complications that arise from bulimia nervosa.

Routine laboratory tests^{[7, 4, 8, 9, 20]}

CBC count: Malnutrition can cause neutropenia and, rarely, anemia or thrombocytopenia.
Biochemistry panel: If dehydration or electrolyte imbalances are suspected, electrolytes, calcium, magnesium, phosphorous, glucose, creatinine, and BUN levels may be obtained to measure liver, kidney, and pancreatic functioning. Common findings include the following:
- Dehydration
- Hypokalemia - Secondary to purging, or use of diuretic or laxatives
- Hypochloremia - Secondary to purging and laxative or diuretic use
- Hypocalcemia
- Hypomagnesemia - Due to diarrhea resulting from laxative use
- Hypophosphatemia
- Hyponatremia - Secondary to use of diuretics
- Metabolic acidosis - Secondary to laxative use
- Metabolic alkalosis - Secondary to purging
- Increased BUN levels
Endocrine studies in patients with bulimia nervosa may exhibit the following abnormal findings:
- Decreased follicle-stimulating hormone (FSH), leuteinizing hormone (LH), and estradiol levels
- Prolactin levels: Studies have documented both increased and decreased basal serum prolactin in association with bulimia nervosa.
- Increased cortisol levels; positive dexamethasone suppression test result
Thyroid and parathyroid panels
- Hypothyroidism can occur as a mechanism of energy conservation.
- Decreased free triiodothyronine (FT3) and free thyroxine (FT4) levels may be observed.
Gastrointestinal laboratory tests may reveal the following:
- Increased amylase secondary to vomiting
- Esophagitis, pancreatitis, or delayed gastric emptying
- Liver function test results usually normal

Situational laboratory tests^{[8, 21, 9]}

A drug screen may be indicated for patients with possible drug use. Attention should be paid to adolescent confidentiality anytime drug testing involves an adolescent patient.^[22]
Ipecac use can cause emetine cardiomyopathy, hepatic toxicity, or peripheral myopathy. Hypokalemia can also result, and the following laboratory studies may be indicated for patients suspected of using ipecac:
- Stool and urine analyses for emetine (a byproduct of ipecac)
- Cardiac assessment - Muscle enzyme values, lipid levels, magnesium, zinc, electromyography
- Electrocardiography (Findings may include cardiac arrhythmias, a prolonged QT interval, ipecac cardiomyopathy.)

Other Tests

ECG should be considered in the following conditions:

Hypokalemia: This condition can cause cardiac conduction defects that may lead to heart arrhythmias or seizures.^[9]
Severe purging behaviors or suspected ipecac use
Symptoms and signs of arrhythmias

Gastric motility studies should be considered in the following conditions:

Prolonged history of bulimia
History of constipation (often due to chronic use of laxatives)
Recent weight loss: Consider other causes of vomiting such as superior mesenteric artery (SMA) syndrome
Other unexplained abdominal pain

Treatment & Management

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Author

Maggie A Wilkes, MD Resident Physician, Department of Psychiatry, Medical University of South Carolina College of Medicine

Maggie A Wilkes, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Medical Association, American Psychiatric Association

Disclosure: Nothing to disclose.

Coauthor(s)

Eve G Spratt, MD, MSc Professor of Pediatrics and Psychiatry, Division of Developmental Pediatrics, Medical University of South Carolina; Director, Pediatric Consultation Liaison Psychiatry, Medical University of South Carolina Children's Hospital at Charleston

Eve G Spratt, MD, MSc is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Angelo P Giardino, MD, PhD, MPH, FAAP Wilma T Gibson Presidential Professor and Chair, Department of Pediatrics, University of Utah School of Medicine; Chief Medical Officer, Intermountain Primary Children's Hospital

Angelo P Giardino, MD, PhD, MPH, FAAP is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, International Society for the Prevention of Child Abuse and Neglect, Ray E Helfer Society

Disclosure: Nothing to disclose.

Acknowledgements

Libby N Brockman Clinical Research Assistant, Center for Clinical and Translational Research, Seattle Children's Hospital; Research Assistant, Department of Pediatrics, University of Washington, Seattle

Disclosure: Nothing to disclose.

Robert Judd, MD Associate Professor, Department of Pediatrics, Division of Pediatric Gastroenterology, University of Wisconsin at Madison

Robert Judd, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Megan A Moreno, MD, MEd, MPH Assistant Professor, Department of Pediatrics, Section of Adolescent Medicine, University of Wisconsin-Madison School of Medicine and Public Health

Megan A Moreno, MD, MEd, MPH is a member of the following medical societies: Society for Adolescent Medicine

Disclosure: Nothing to disclose.

Patricia Quigley, MD Resident Physician, Department of Pediatrics, University of Wisconsin Hospital and Clinics

Patricia Quigley, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.