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Correction to Mehler, N Engl J Med 349(9):875-881 August 28, 2003.

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Volume 349:2363-2364 December 11, 2003 Number 24
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Bulimia Nervosa

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by Mehler, P. S.
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To the Editor: In Dr. Mehler's discussion of the physiological complications of bulimia nervosa (Aug. 28 issue),1 he emphasizes the diagnostic usefulness of urinary electrolyte measurements and concludes that low urinary potassium and sodium concentrations are compatible with vomiting. The amount of potassium in gastric secretions is actually trivial, and the mechanism of hypokalemia in such persons is urinary potassium loss, which occurs as high distal delivery of bicarbonate enhances potassium secretion in the cortical collecting duct.2,3,4 In addition, there is an obligatory loss of sodium with bicarbonate after each bout of vomiting. Therefore, the urinary hallmarks of active vomiting . . . [Full Text of this Article]



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