Hypokalaemia
Sherif Gonem, Ian Pavord in Diagnosis in Acute Medicine, 2017
Hypokalaemia may be caused by the following mechanisms: renal potassium loss; extra-renal electrolyte loss; edistribution of potassium from the extracellular to the intracellular compartment; and poor potassium intake. The vast majority of potassium in the body is present within the intracellular compartment, and therefore the serum potassium concentration reflects both total body potassium and the relative distribution of potassium between the intracellular and extracellular compartments. Hypokalaemia is often asymptomatic, but may cause muscle weakness or polyuria. Metabolic alkalosis may occur with severe hypokalaemia in general, and particularly with conditions of mineralocorticoid excess, as well as in Bartter's, Liddle's and Gitelman's syndromes. Loss of sodium chloride from the gastrointestinal tract or skin results in hypovolaemia with secondary hyperaldosteronism, as well as metabolic alkalosis. Both of these factors cause increased renal potassium excretion. Chronic vomiting due to bulimia or anorexia nervosa may lead to dental caries and parotid enlargement. Additional signs of anorexia nervosa include low body mass index and lanugo hair.
The Female Athlete Triad
Published in The Physician and Sportsmedicine, 1996
In brief The female athlete triad of disordered eating, amenorrhea, and osteoporosis affects women and girls in many sports, but the messages conveyed to those in “appearance” sports like gymnastics may play a role. Because the triad may result in irreversible bone loss and death, early detection is imperative. Friends, parents, coaches, and physicians can be alert to behaviors like eating alone, trips to the bathroom during or after meals, and the use of laxatives. Other signs and symptoms of the female athlete triad may include fatigue, anemia, depression, cold intolerance, lanugo, and eroded tooth enamel from frequent vomiting. Multidisciplinary treatment typically involves education, determining contributing factors, restoring adequate nutrition, and prescribing estrogen therapy when appropriate.
Team Management of the Female Athlete Triad
Published in The Physician and Sportsmedicine, 1997
Elizabeth Joy, Nancy Clark, Mary Lloyd Ireland, Joseph Martire, Aurelia Nattiv, Steve Varechok
The female athlete triad of disordered eating, amenorrhea, and osteoporosis affects many active women and girls, especially those in sports that emphasize appearance or leanness. Because of the athlete's psychological defense mechanisms and the stigma surrounding disordered eating, physicians may need to ask targeted questions about nutrition habits when assessing a patient who has a stress fracture or amenorrhea, or during preparticipation exams. Carefully worded questions can help. Physical signs and symptoms include unexplained recurrent or stress fracture, dry hair, low body temperature, lanugo, and fatigue. Targeted lab tests to assess nutritional and hormonal status are essential in making a diagnosis that will steer treatment, as are optimal radiologic tests like dual-energy x-ray absorptiometry for assessing bone density.
Skin signs in anorexia nervosa
Published in Dermato-Endocrinology, 2009
Anorexia nervosa (AN) is a significant cause of morbidity and mortality among adolescent females and young women. AN is associated with severe medical and psychological consequences, including death, osteoporosis, growth delay, and developmental delay. Skin signs are almost always detectable in severe AN and awareness of them may help in the early diagnosis of hidden AN. Skin signs are the expression of the medical consequences of starvation, vomiting, abuse of drugs, such as laxatives and diuretics, and of the psychiatric morbidity. They include xerosis, lanugo-like body hair, telogen effluvium, carotenoderma, acne, hyperpigmentation, seborrhoeic dermatitis, acrocyanosis, perniosis, petechiae, livedo reticularis, interdigital intertrigo, paronychia, acquired striae distensae, acral coldness. The most characteristic cutaneous sign of vomiting is Russell's sign (knuckle calluses). Symptoms due to laxative or diuretic abuse include adverse reactions by drugs. Symptoms due to psychiatric morbidity (artefacta) include the consequences of self-induced trauma. The role of the dermatologist in the management of eating disorders is to make an early diagnosis of the "hidden"signs of eating disorders in patients who tend to minimize or deny their disorder.