Abuse and clinical value of diuretics in eating disorders therapeutic applications

Objective: Diuretic abuse as a means of purging is common in patients with bulimia nervosa. We sought to illustrate the pathophysiologic effects of diuretics and purging on a patient with bulimia nervosa's fluid and electrolyte status and to clarify the role of diuretics in the management of volume status during refeeding. Method: We reviewed the literature pertaining to diuretic abuse, purging, bulimia nervosa, and diuretic therapy. Results: Purging behaviors lead to volume depletion and a state of heightened aldosterone production. Patients with bulimia nervosa commonly undergo rapid rehydration with intravenous fluid administration. In the setting of hyperaldostreronism, aggressive rehydration leads to avid salt retention and the development of marked amounts of edema. Discussion: Providers should understand both the background renal pathophysiology of the patient with bulimia nervosa and the mechanisms of action of diuretics to correctly use diuretics as focused therapeutic agents for this patient population.