General

Brain (neurologic/psychiatric)

Head and neck

– Weakness, fatigue, lethargy

– Dizziness, syncope

– Weight fluctuations: marked weight loss or gain

– Arrested linear growth

– Cold intolerance

– Sweating/hot flashes

– Poor concentration and memory

– Altered cognition

– Insomnia

– Features of depression, anxiety, obsessive-compulsive disorder

– Social withdrawal

– Irritability

– Dental enamel erosion and caries

– Parotid enlargement (from self-induced vomiting)

– Oral trauma and lacerations

– Dry, cracked lips and tongue

Cardiac and pulmonary

Gastrointestinal

Endocrine

– Dysrhythmias

– Palpitations

– Chest pain

– Shortness of breath

– Edema

– Dizziness

– Orthostatic heart rate and blood pressure changes

– Delayed capillary refill

– Acrocyanosis

– Constipation or diarrhea

– Gastroesophageal reflux

– Abdominal discomfort/bloating

– Delayed gastric emptying, early satiety

– Hemorrhoids, prolapse

– Hematemesis

– Amenorrhea or irregular menses

– Delayed pubertal development

– In diabetes, poor glucose control and possible diabetic ketoacidosis

– Infertility

Renal/metabolic

Dermatologic

Musculoskeletal

– Renal calculi

– Edema

– Dehydration

– Incontinence

– Dry skin

– Carotenoderma

– Hair loss or thinning

– Brittle nails

– Lanugo

– Poor wound healing

– Russell sign: calluses on the knuckles or dorsum of the hand due to self-induced vomiting

– Decreased bone mineral density/osteoporosis, risk of bone fractures

– Fatigue

– Muscle weakness

– Cramps