Abstract

Fluid and electrolyte derangements occur frequently in patients with vomiting and anorexia nervosa and contribute to protracted morbidity and a mortality reported to be as high as 22%, probably from hypokalemia. Hypochloremic, hypokalemic metabolic alkalosis is characteristic, in conjunction with significant intravascular volume depletion and hypotension. Exceedingly low urinary chloride concentrations confirm a shrunken vascular space. Treatment with intravenous isotonic saline or oral salt tablets and fluid will resolve these abnormalities, and the urinary chloride level will be the best guideline of euvolemia.