A dangerous combination of binge and purge

Stern, Julian, Culkin, Alison, Gabe, Simon M and Peake, Simon T C (2011) A dangerous combination of binge and purge. International Journal of Eating Disorders, 44 (2). pp. 302-304. ISSN 1098-108X (Online)

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We present a 36-year-old female diagnosed with Crohn's disease at the age of 11 years. In 2001, she underwent a total colectomy and further small bowel resection as a result of active Crohn's. Her residual anatomy consisted of 150 cm of small bowel to an end jejunostomy. Subsequently, she developed short bowel syndrome with recurrent episodes of hypomagnesaemia, hypocalcaemia, and hypokalaemia. Dietetic assessment revealed her to be severely underweight at 37 kg with a bodymass index (BMI) of 14.4 kg/m2. During her admission, our patient underwent psychiatric assessment and was established on home parenteral nutrition (HPN). At the time of discharge, 1 month later, her weight had increased to 44 kg (BMI = 17.7 kg/m2). Over the following 12-month period, she lost weight (BMI, 15.4 mg/m2; weight, 39.5 kg) and she described a high stoma output (up to 17 L) and dehydration. Assessment of her oral intake found she was consuming an estimated 14,000 kcal and 600 g protein per day. At this time, the possibility of a new form of eating disorder was discussed with the patient and she agreed that her behavior i.e., using her stoma as a purging device, fulfilled the criteria for a diagnosis of bulimia nervosa and she was referred to a specialist eating disorder unit.

Item Type: Article
Additional Information: Article first published online: 23 Mar 2011
Uncontrolled Keywords: Bulimia Nervosa, Stoma, Crohn's Disease, Home Parenteral Nutrition
Subjects: Disabilities & Disorders (mental & physical) > Eating Disorders
Department/People: Adult and Forensic Services
URI: https://repository.tavistockandportman.ac.uk/id/eprint/1179

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