Physical assessment of patients with anorexia nervosa and bulimia nervosa: an international comparison

Objective: A questionnaire study was carried out to determine which investigations were carried out routinely on patients with anorexia nervosa and bulimia nervosa. Method: A specially designed questionnaire was sent to 168 clinicians working in the field of eating disorders in 25 countries. Respondents were asked to supply information about how often they carry out specific investigations on new patients with AN and BN. The questionnaire covered the use of physical examination, biochemical and haematological tests and cardiac investigations. Results: 71 (42.3 per cent) questionnaires were returned. Biochemical investigations and full blood counts were carried out frequently. Significant differences were found between AN patients and BN patients in the measurement of calcium, phosphate and magnesium levels. In some cases, patients with BN were not routinely assessed for hypokalaemia. Micronutrient levels were measured rarely and only 40 per cent of respondents carried out routine electrocardiograms (ECGs) in AN. Discussion: Measurement of serum potassium should be routine in BN and other electrolytes should probably measured more often in both disorders. Detection of treatable micronutrient deficiencies should be given more emphasis and the ECG should become a routine investigation in AN.