Electrolyte Issues From Bulimia – Knowing the Warning Signs

Electrolytes like calcium, sodium, and potassium help your body transmit electrical impulses, and they move from cell to cell through fluids in your tissues.

If your hydration levels rise or fall dramatically, you could develop electrolyte issues.[1] Unfortunately, this is common in people with bulimia.

Almost half of all people with bulimia have electrolyte imbalances.[2] A bulimia electrolyte imbalance can cause dizziness, confusion, and swelling in your hands and feet. If left untreated, these issues can cause life-threatening complications, including heart damage.

3 Reasons Bulimia Can Cause Electrolyte Imbalances

Vomiting and laxative abuse account for about 90% of the purging behaviors people with bulimia use.[3] These methods can lead directly to electrolyte issues.

1. Vomiting & Electrolytes

Purging can be described as self-induced vomiting. Often, individuals will use a tool or their finger to induce vomiting after a binge episode. Various side effects come along with purging behaviors.

Each time you vomit, you lose fluid as well as food. You also lose the salts and electrolytes in your meals through your vomiting episodes. Both can lead to electrolyte imbalances.

2. Laxative Abuse & Electrolytes

Laxatives affect both the gastrointestinal system (GI) and the body’s electrolyte balances.

Electrolytes lost through laxative abuse can include chloride, calcium, bicarbonate, and potassium. Hypokalemia can lead to the slowing of the intestine and its function, which can lead to swelling.

3. Dehydration & Electrolytes

Regular vomiting and laxative abuse leave your tissues starved of fluids. Electrolytes can’t move from place to place. If you do replace them through eating, they may leave your body again, as there is no fluid to retain them.

What Electrolyte Abnormality in Bulimia Looks Like

People with bulimia may not recognize electrolyte issues right away, but when the problem is severe, the signs are significant and hard to ignore.

In a hospital setting, people with electrolyte imbalances often experience the following:[4]

• Confusion
• Swelling
• Rattling sounds while breathing
• Heart rate abnormalities

If you are concerned that your loved one has bulimia and may medically be in danger, that person should be assessed by your medical provider or closest emergency room/urgent care clinicians.

When looking to test for electrolyte imbalances, it is good to get a complete blood count (CBC) test, urinalysis, metabolic profile, serum magnesium, thyroid test, and electrocardiogram conducted.

Treating Complications of Electrolyte Imbalances

If left untreated, electrolyte issues can lead to significant heart and neurological problems.

Doctors can replace missing electrolytes and fluids with IV lines, and they can use calcium to ease heart problems. Some people need insulin to lower high potassium levels, and some need salts to correct their chemistry.[5]

Your doctor may need to watch your lab work closely, as rebound cases can occur. And you will need treatment for your eating disorder. These therapies don’t address why your electrolytes were off in the first place.

Signs of Bulimia You Should Know

Electrolyte imbalances are complications of bulimia. The more you know about what this eating disorder looks like, the better you can help someone you love before physical problems grow harder to treat.

Common signs of bulimia families notice include the following:

• Using the bathroom frequently after meals
• Isolation after meals, either in the restroom or another area of the house
• Finding “tools” in the bathroom or hidden, such as toothbrushes, spoons, or other objects for inducing vomiting
• Finding laxative or diuretic packages
• Noticing dry mouth or smelly breath in your loved one more frequently
• Reports of a frequent sore throat or acid reflux
• Edema, or swelling in the legs
• Puffy face, or appearance of more swelling in the face
• Red or teary eyes after going to the bathroom due to the havoc of purging

These symptoms do not encompass all of the ones your loved one may be having, but they are some of the more significant concerns to look for.

Many of these symptoms, both internally and externally, can be reversed in many individuals. Offering support, compassion, and hope to your loved one is essential when getting them the care they need.

Related Reading

• Electrolytes and bulimia
• Nutritional counseling for eating disorders

Electrolyte Issues & Bulimia FAQs

Does vomiting cause hypokalemia?

Hypokalemia is a medical term meaning potassium deficiency. Yes, bulimia can cause this condition, especially if the person is vomiting frequently.

Can bulimia cause low potassium?

Yes. This condition is also known as hypokalemia, and it’s a common issue in people who vomit regularly as part of bulimia.

How can you tell if your electrolytes are off?

Significant swelling in the hands, feet, and face is common in people with electrolyte imbalances. You may also feel confused, and your heart may feel like it’s racing.

Can electrolytes cause swelling?

Purging behaviors like vomiting and abusing laxatives reduce electrolytes and fluids in your body. Your tissues respond by holding onto every drop of liquid they can access, which can look like swelling to you.[6] This is a known and severe complication of bulimia.

References

1. Fluid and Electrolyte Balance. U.S. National Library of Medicine. https://medlineplus.gov/fluidandelectrolytebalance.html. June 2016. Accessed July 2022.
2. Electrolyte and Other Physiological Abnormalities in Patients with Bulimia. Psychological Medicine. https://www.cambridge.org/core/journals/psychological-medicine/article/abs/electrolyte-and-other-physiological-abnormalities-in-patients-with-bulimia/C42B3E363A947749EEA4697379E5F8DB. July 2009. Accessed July 2022.
3. Medical Complications of Bulimia Nervosa. Cleveland Clinic Journal of Medicine. https://www.ccjm.org/content/88/6/333. June 2021. Accessed July 2022.
4. General Characteristics of Patients with Electrolyte Imbalance Admitted to Emergency Department. World Journal of Emergency Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129840/. 2013. Accessed July 2022.
5. Potassium Disorders: Hypokalemia and Hyperkalemia. American Family Physician. https://www.aafp.org/pubs/afp/issues/2015/0915/p487.html. 2015. Accessed July 2022.
6. PseudoBartter Syndrome in Eating Disorders. International Journal of Eating Disorders. https://pubmed.ncbi.nlm.nih.gov/21344464/. January 2012. Accessed July 2022.