What are the potential medical complications of bulimia nervosa that I should monitor in my patients?

Potential medical complications of bulimia nervosa to monitor include:

• Electrolyte imbalances such as hypokalaemia, which can lead to cardiac dysrhythmias and prolonged QT interval, especially in patients engaging in purging behaviors like vomiting, laxative or diuretic misuse ¹,².
• Cardiac complications including bradycardia and arrhythmias; ECG monitoring is recommended for those with severe purging, significant weight changes, or on medications affecting cardiac function ¹,².
• Dental erosion and oral health problems due to repeated vomiting; patients should be advised to avoid brushing teeth immediately after vomiting and to rinse with water or non-acidic mouthwash ¹,².
• Gastrointestinal issues such as chronic laxative misuse leading to dependency and potential bowel dysfunction ¹.
• Dehydration and malnutrition, which may cause muscular weakness and hypotension ¹,².
• Risk of paracetamol toxicity due to low body weight and altered metabolism ¹.
• Potential for severe electrolyte disturbances requiring acute medical care or inpatient admission if severe ².

Regular monitoring in primary care should include weight/BMI, blood pressure, relevant blood tests including electrolytes, and ECG where indicated ¹,². Coordination with specialist services is essential for managing these complications effectively ¹.