Dangers of Eating Disorders - The Case of Terri Schiavo

Mar 25 2005

The U.S. Supreme Court refused today to hear an appeal by the parents of Terri Schiavo, the 41-year-old Florida woman who has been in a vegetative state since she collapsed in 1990. As controversial as this case has been, little has been written about the eating disorder that supposedly led to her heart failing long enough to deny needed oxygen to her brain. Scripts-Howard columnist and Law professor Paul Campos has written that "On the night she collapsed Terri had just eaten dinner. She went into the bathroom and forced herself to vomit. Apparently, the chemical imbalance brought on by her bulimia stopped her heart." (Campos, 2005)

According to Campos and others Terri Schiavo grew up as a chubby girl who wanted to be thin. ABC News reported that she weighed as much as 200 pounds at a height of 5'3". Press sources also report that she went on a liquid diet to lose weight. A lawyer who represented the Schiavos in a malpractice case reported that her heart failure in 1990 was due to a potassium imbalance resulting from an eating disorder.

Eating disorders cause more deaths than any other mental health problem (with the possible exception of depression). Some people still don't take these disorders seriously; but we know that eating disorders such as anorexia nervosa and bulimia can cause a number of medical problems. A 1999 New England Journal of Medicine article listed the following medical consequences of eating disorders:

Orofacial:

• Perimolysis (enamel erosion)
• Dental caries
• Cheilosis (erosion of the lip or cracking at the corners of the mouth)
• Enlargement of the parotid gland
• Submandibular adenopathy (enlarged painful ymph nodes located beneath the mandible)

Cardiovascular:

• Postural and nonpostural hypotension (low blood pressure)
• Acrocyanosis (decrease in the amount of oxygen delivered to the extremities)
• Electrocardiographic abnormalities: low voltage, prolonged QT interval, prominent U waves
• Sinus bradycardia
• Atrial and ventricular arrhythmias
• Left ventricular changes: decreased mass, decreased cavity size
• Mitral-valve prolapse
• Cardiomyopathy (due to ipecac poisoning)

Gastrointestinal:

• Esophagitis, hematemesis (vomiting of fresh red blood - including the Mallory–Weiss syndrome)
• Delayed gastric emptying
• Decreased intestinal motility
• Constipation
• Rectal prolapse
• Gastric dilatation and rupture
• Abnormal results on liver-function tests
• Elevated serum amylase level

Endocrine and metabolic:

• Hypokalemia (low calcium - including hypokalemic nephropathy)
• Hyponatremia (low sodium), (rarely) hypernatremia (high sodium)
• Hypomagnesemia (low magnesium)
• Hyperphosphatemia (high phosphate)
• Hypoglycemia (low blood sugar)
• Hypothermia
• Euthyroid sick syndrome
• Hypercortisolism, elevated free cortisol level in urine
• Low serum estradiol level
• Decreased serum testosterone level
• Amenorrhea, oligomenorrhea
• Delay in puberty
• Arrested growth
• Osteoporosis
• Lipid abnormalities
• Obesity

Renal (kidneys):

• Renal calculi

Reproductive:

• Infertility
• Insufficient weight gain during pregnancy
• Low-birth-weight infant

Integumentary (skin, hair, nails):

• Dry skin and hair
• Hair loss
• Lanugo
• Yellow skin due to hypercarotenemia
• Hand abrasions

Neurologic:

• Peripheral neuropathy
• Reversible cortical atrophy
• Ventricular enlargement

Hematologic (blood):

• Anemia, leukopenia, neutropenia, thrombocytopenia

References:

Becker A. E., Grinspoon S. K., Klibanski A., Herzog D. B., Current Concepts: Eating Disorders. N Engl J Med 1999; 340:1092-1098, Apr 8, 1999.

Campos, Paul. The other tragedy: Terri's eating disorder Thursday, March 24, 2005. NorthJersey.com

Last updated 11/5/05