Hypokalemia leading to torsades de pointes: Munchausen's disorder or bulimia nervosa?

Lois Elaine Krahn, Josephine Lee, J. W. Richardson, M. J. Martin, M. K. O'Connor

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

A 45-year-old woman traveled over 1000 miles from a major metropolitan area to obtain another opinion for medically refractory diarrhea. She had an extremely complicated medical history with no outside records or family members accompanying her to give collateral history. She had multiple previous diagnostic evaluations including 13 surgical procedures and many therapeutic trials of various medications. She acknowledged a preoccupation with weight and appearance, described previous attempts to diet, and repetitively denied purging, including laxative abuse. During her hospitalization she had two episodes of torsades de pointes requiring cardiac defibrillation. Laboratory testing revealed hypokalemia at the time of these events, and a toxicology screen was positive for bisacodyl, confirming laxative abuse. When confronted by a combined team of cardiology, gastroenterology, and psychiatry specialist, she admitted her laxative abuse and surrendered her supply of Dulcolax tables. The discussion addresses the procedures employed to detect her surreptitious medication use, the near lethal cardiac complications, and the appropriate psychiatric diagnosis.

Original languageEnglish (US)
Pages (from-to)370-377
Number of pages8
JournalGeneral Hospital Psychiatry
Volume19
Issue number5
DOIs
StatePublished - Sep 1997

Fingerprint

Torsades de Pointes
Bulimia Nervosa
Laxatives
Hypokalemia
Bisacodyl
Gastroenterology
Cardiology
Mental Disorders
Toxicology
Psychiatry
Diarrhea
Hospitalization
History
Diet
Weights and Measures
Therapeutics

ASJC Scopus subject areas

  • Emergency Medicine
  • Medicine(all)
  • Psychiatry and Mental health

Cite this

Hypokalemia leading to torsades de pointes : Munchausen's disorder or bulimia nervosa? / Krahn, Lois Elaine; Lee, Josephine; Richardson, J. W.; Martin, M. J.; O'Connor, M. K.

In: General Hospital Psychiatry, Vol. 19, No. 5, 09.1997, p. 370-377.

Research output: Contribution to journalArticle

Krahn, Lois Elaine ; Lee, Josephine ; Richardson, J. W. ; Martin, M. J. ; O'Connor, M. K. / Hypokalemia leading to torsades de pointes : Munchausen's disorder or bulimia nervosa?. In: General Hospital Psychiatry. 1997 ; Vol. 19, No. 5. pp. 370-377.
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