Many of the physical symptoms of AN arerelated directly to the effects of semi-starvation, while other physical symptoms areassociated mainly with behavioral problems such as excessive exercising, vomiting, and purging. Table 5.1 lists the most common physical manifestations in AN. Table 5.2 lists the physical manifestations most commonly found in BN.

Edema

Case

A 25-year-old female gains 10 kg in seven days. She is extremely anxious and agitated and threatens to discharge herself against medical advice. The nurse asks you why she has gained so much weight.

Comment

During feeding, edema occurs due to volume depletion, low metabolic rate, behaviors such as vomiting and laxative, enema, and diuretic use, which cause the body to have high circulating hormones that promote the retention of fluid. Antidiuretic hormone is secreted by the pituitary, renin is secreted by the kidney, angiotension is formed in the blood, and aldosterone is produced by the adrenal gland. The amount of fluid that might be retained in a patient is impossible to predict, but it is often 3—5 kg of water. The fluid retention is much greater in patients with a history of binge—purge behavior or diuretic use.

If the patient is suspected of having edema, apply steady, firm pressure with the pad of your thumb over the skin covering the lower tibia, just about the ankle. After 15 seconds, a small pit will appear if edema is present.