Electrolytes and Bulimia: Why Is This a Big Deal?

Contributor: Leigh Bell, BA, A Center for Eating Disorders

glass of waterBulimia is devastating disease to the mind, soul, and body; and it is in the body where regular purging creates potentially fatal electrolyte imbalances.

Electrolytes are electrically charged salts, or ions, used by the body to regulate hydration and Ph levels, as well as nerve and muscle function. Muscle tissues and neurons are electric tissues, and they’re activated by electrolytes leaving and entering the cell membrane.

For example, muscle contraction requires the right levels of calcium, sodium, and potassium. When levels are out of whack, muscles go weak, contract too severely, or stop working altogether. The heart, essentially a mighty muscle, can also be compromised — some times irreparably — by imbalanced electrolytes, including:

  • Sodium
  • Potassium
  • Calcium
  • Magnesium
  • Bicarbonate

How Electrolytes Fluctuate

Electrolyte levels are determined by hydration — how much water is in the body — and levels of water can be precariously unstable in the body of someone who’s regularly vomiting and/or abusing diuretics and laxatives. Have you ever had a muscle aches, cramps, or twitches during or after a nasty stomach flew? It was probably the result of dehydration, which threw off electrolytes, which affected muscle function.

You likely began to feel better, drank some water, and rebalanced the electrolytes — no problem. Prolonged and chronic dehydration from purging, on the hand, can cause critical health issues. What method a person with bulimia uses to purge and how often he/she does it determines the type and severity of electrolyte imbalance, which is revealed in blood tests1.


Food For SkincareLow potassium level, or hypokalemia, is the most serious consequence of bulimia because it causes heart arrhythmias (irregular heartbeats), cardiomyopathy (weakening heart), muscle weakness that can border on paralysis, and tetany (involuntary muscle contractions)2. The condition can lead to a sudden, devastating death, as in the case of Katie Stream.

Katie’s dad, former Missouri Senator Rick Stream, 20 years ago walked into his daughter’s room singing a good-morning song and opening her blinds to begin the day, but Katie didn’t move. The 18-year-old, who had long struggled with bulimia, died earlier that morning because her body’s potassium levels were so low, her heart stopped beating3.

Though serious, hypokalemia is uncommon in bulimics (about 4.6%), but those with the condition usually have low-body weight and purge with self-induced vomiting, laxatives, or both.


Low blood levels of calcium, called hypocalcemia, can occur from long-term use of diuretics to purge. Hypocalcemia can fatally affect the heart in the short term, but it usually doesn’t. The larger concern of hypocalcemia is the leaching of calcium from bones, which can cause osteoporosis4.


Hypomagnesemia is low levels of magnesium in the blood and can be caused by chronic abuse of laxatives, among other purging methods. It can create “disturbances in nearly every organ system and can cause potentially fatal complications.”5


Potato chips.Hypernatremia is high sodium levels in ratio to water in the blood because of dehydration, which can be caused by purging through self-induced vomiting and/or abuse of diuretics and/or laxatives. Basically, the cells become dehydrated, causing muscle cramps, seizures, headache, lethargy, intracranial hemorrhage, coma, and even death6.


This electrolyte, a form of carbon dioxide, helps to buffer the acids that build up in a person’s body as usual byproducts of metabolism. For example, when a person’s muscles are working they produce lactic acid as a byproduct of energy formation7. When there’s not enough bicarbonate, pH levels can increase in the body’s tissue causing metabolic alkalosis.

A Symptom, but not a Diagnosis

It’s important to realize the danger of electrolyte imbalance but also to know the condition doesn’t occur in the vast majority of people with bulimia. So although severe hypokalemia in an otherwise healthy young person specifically suggests bulimia, most people who purge don’t develop electrolyte abnormalities (Mehler, 2004).

Therefore, screening for electrolyte imbalances is not an effective means to detect purging or diagnose bulimia.

Community Discussion: Share your thoughts here!

Have you or someone you love struggled with electrolyte balance with bulimia? What steps were taken to improve this in recovery? What advice do you have to share?

About the Author:

Leigh Bell holds a Bachelor of Arts in English with minors in Creative Writing and French from Loyola Marymount University in Los Angeles. She is a published author, journalist with 15 years of experience, and a recipient of the Rosalynn Carter Fellowship for Mental Health Journalism. Leigh is recovered from a near-fatal, decade-long battle with anorexia and the mother of three young, rambunctious children.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on June 19th, 2015
Published on EatingDisorderHope.com