1/4. death due to chronic syrup of ipecac use in a patient with bulimia.A 17-year-old girl presented with malaise, weakness, palpitations, dysphagia, myalgias, and weight loss of 1 month's duration. Within 24 hours of admission to the hospital, she had hypotension unresponsive to medical management, intractable congestive heart failure, and arrhythmias; she died. Several empty bottles of syrup of ipecac were later found among her belongings. Syrup of ipecac is commonly used to induce emesis in patients who had ingested toxic substances. The chief pharmacologic property of this agent is due to its alkaloid component, emetine. There have been many previous reports of death due to emetine poisoning in patients receiving ipecac fluid extract and in those treated for amoebic dysentery. However, the literature cites only three case reports of fatalities secondary to chronic ipecac use as a means of losing weight. This is the first report of a death due to chronic ipecac use in an adolescent patient with bulimia. emetine persists in the body for long periods, and in patients who have ingested it chronically, emetine is extremely toxic, specifically to cardiac smooth and skeletal muscles. With an increased awareness of the importance of weight control in the adolescent age group, the physician must carefully evaluate these patients for the use of emetics.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. hand lesions characteristic of bulimia.bulimia is a serious and prevalent eating disorder in the adolescent population. The pediatrician is often in a position to make the initial diagnosis of bulimia but must suspect the disorder in light of subtle physical evidence. Denial and embarrassment reduce the likelihood of self-report of symptoms. hand lesions resulting from self-induced emesis have a distinctive configuration and appearance. Noting these characteristic lesions during a physical examination should alert a physician to the diagnosis of bulimia or to an exacerbation of symptoms in a patient whose condition was previously diagnosed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. bulimia: the binge eating syndrome.bulimia occurs in roughly half of obese and anorexic patients. A recent study found 19% of female and 5% of male college students to be bulimic. Binge eating usually comes to the physician's attention from problems associated with purging measures--diuretics, laxatives, or self-induced postprandial vomiting--used by one out of ten bulimic patients. Continuous vomiting causes parotid enlargement, sore throat, spontaneous regurgitation, and severe electrolyte imbalance. We report a case illustrating the bulimic's distorted body image, review alternative treatment methods, and suggest needed areas of research, particularly those elucidating the relationship between bulimia and affective disorders.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Abstaining and bulemic anorexics. Two sides of the same coin.This article presents a psychodynamic approach to the understanding and treatment of abstaining and bulemic anorexics. While the abstainer starves herself to the point of emaciation and the bulemic may gorge to the point of obesity, the underlying emotional conflicts of the two groups of patients are the same. The ego (character structure) of the bulemic is not as perfectionistic and rigid as that of the abstainer, so the patient is periodically overwhelmed not only by impulses to gorge but also by impulses of all kinds. A description of the clinical syndrome, the physiological findings and details of the laboratory diagnosis of anorexia nervosa are provided. family psychodynamics which are viewed as etiologic are presented. A psychodynamic therapeutic approach is described and examples of the treatment of an abstaining and bulemic patient are detailed. The crucial therapeutic role of the family physician is explored with emphasis on the importance of the physician's encouraging the patient to bring up questions about food and eating with the psychiatrist because such preoccupations mask other conflicts.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |