The vomiting that many bulimic sufferers induce is the most physically destructive method of purging. Indeed, the majority of health problems associated with bulimia nervosa arise from vomiting:
• Repeated exposure of teeth to the acid in vomit causes demineralization, making the teeth painful and sensitive to heat, cold, and acids. Eventually, the teeth may severely decay, erode away from fillings, and finally fall out. Dental professionals are sometimes the first health professionals to notice signs of bulimia nervosa. Until vomiting ceases, it is important to rinse the mouth with water after a vomiting episode, especially before brushing the teeth.
• Blood potassium can drop significantly with regular vomiting or the use of certain diuretics. This can disturb the heart's rhythm and even produce sudden death.
• Salivary glands may swell as a result of infection and irritation from persistent vomiting.
• Stomach ulcers and bleeding and tears in the esophagus develop in some cases.
• Constipation may result from frequent laxative use.
• Ipecac syrup, sometimes used to induce vomiting, is toxic to the heart, liver, and kidneys. It has caused accidental poisoning when taken repeatedly.
Overall, bulimia nervosa is a potentially debilitating disorder that can lead to death, usually from suicide, low blood potassium, or overwhelming infections.