Apparently, it's not unusual for an autopsy to be inconclusive when someone dies from an eating disorder.
Eating disorders are usually associated with an increased risk of premature death with a wide range of rates and causes of mortality. “Sudden death” has been defined as the abrupt and unexpected occurrence of fatality for which no satisfactory explanation of the cause can be ascertained. In many cases of sudden death, autopsies do not clarify the main cause.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3292410/
You are correct, sadly, for eating disorders are killers which do go unreported. However, I have learned down through the years that there are some markers/ signs of an eating disorder if it was of long duration or if it was severe. Postmortem signs could include ( I am going on memory here): enlarged or torn small blood vessels in the eyes and esophagus, discolored or eroded teeth, parotiditis, gastroparesis, erythema and edema of some but not all fingers, signs of chronic hypo-peristalsis OR hyper- peristalsis ( if taking laxatives), ano-rectal tears consistent with chronic constipation.
What this means in everyday terms is that bulimia leaves signs behind in the body, as does anorexia. The findings differ.
In a bulimic person, you might find the torn small blood vessels ( capillaries) from the increased pressure caused by inducing frequent vomiting and possibly from excessive gagging and holding the head down over a toilet many times a day. Likewise the stained or eroded teeth, or both are from an excess of vomitus damaging the tooth enamel as it is being expelled from the mouth.
Bulimics of long duration can have the reddish discolored and enlarged knuckles, which we have clearly seen in a photo of a living Peaches Geldof.
Both bulimics and anorexics tend to misuse laxatives after a while, but for different reasons. Bulimics take them ( and use enemas) to get rid of food in the lower gut. Anorexics use a bowel stimulant because when the food intake drops to liquids only, or half an apple a day, the bowels stop working well ( a process called peristalsis). So, they take laxatives to have a bowel movement... also, after a while, anorexics will weigh less after taking many laxative pills per day.
This goes directly back to Karen Carpenter's death. When she died, the emetic drug, syrup of Ipecac, which was taken off most drugstore shelves not too long afterwards, was found in great quantity in her closets and other " hiding" places in her bedroom at her parent's house. It was a contributing factor to her death in addition to the COD which was heart failure. A finding on autopsy was anorexia nervosa. She also had chronic GI tract changes, which I am speaking of, from memory, which are common on an autopsy of a chronically eating disordered person. I have seen the same findings reported on other autopsy reports from chronic bulimics and anorexics who succumbed to cardiac arrest, pneumonia, or sepsis, or other primary causes of death. ( usually complications of a severe eating disorder resulting in starvation).
Syrup of Ipecac had long been in home medicine chests, and once was used in hospital ER depts. as a treatment for overdoses or accidental ingestion of some noxious substances, as it was mistakenly thought to be a safe way to induce vomiting. It was proven in the late 80's to be both ineffective and to have the potential to cause toxicity. I have seen it on some drugstore shelves in the past decade, but now it has a very bad smell, like strong wintergreen, and I have read that the purchase is limited to one or two small bottles per customer in most places.
Gastroparesis refers to the slowing of the stomach emptying contents into the small intestine. On postmortem examination, if anorexia was a contributing factor to death, one might see a report describing excess liquid in the stomach ( stomach acids and possibly orally consumed liquid or a small amount of solids mixed with liquid) retained because the GI motility had chronically slowed down. The body was holding onto food for as long as possible every time food was consumed.
In bulimia, the only
gastric change that I know of which might be found could be an excess of food in the gastrum if the bulimic had not yet purged before dying.
Other reports in a thorough autopsy report which point towards but do not diagnose an eating disorder are abnormal electrolytes ( potassium, sodium, chloride) but these become abnormal shortly after death so the finding is not accurate to state that an eating disorder was present, usually.
Also, there is the issue of BODY FAT present. Usually, the coroner or M.E. will measure the amount of fat on the omentum with calipers and report it in mm. or cm. it any is present. Normally, the omentum of an adult will have SOME fat present as we do need some body fat for temperature regulation and energy storage. Again, this is not diagnostic alone, because a bulimic may be normal weight, underweight or overweight. Likewise, it is possible for an active anorexic who was overweight to die of sudden cardiac failure before reaching the state of being underweight.
Lab test for liver and cardiac enzymes may be normal or may be elevated. The presence of both elevated liver and cardiac enzymes beyond that which one would expect to see as the tissues break down on a cellular level after death do point in the direction of an eating disorder, usually anorexia It would be possible for a bulimic to have abnormal liver enzymes due to what we call " fatty liver".. This should also be seen on microscopic sectioning of the liver.
IF there are notes by the M.E. upon first examination of the corpse at the scene of death, where a core liver temperature is usually taken, there could be notations of excessively poor skin turgor, dry mucous membranes inconsistent with estimated TOD, meaning dehydration. At Peaches' young age, I would not expect to see any microscopic renal cell changes due to chronic dehydration.
That reminds me: Body hair growth. While anorexics and bulimics are prone to excessive scalp hair loss, a person who is in a prolonged or chronic state of starvation ( cachexia) will often grow fine baby soft hair all over, such as a newborn baby has for a few days to a few weeks. An adult body does this to try to retain normal body temperature, as severe eating disorders cause a slowing of both heart rate and a lowering of basal body temperature. Blood pressure is also usually low chronically but this is not a postmortem finding, obviously.
This is all very gruesome, and I apologize to any who have lost a loved one to an eating disorder, or to any WSers who are recovering. I put a warning in front of the post because this is the worst thing I have ever needed to describe in medical and laymen's terms. I have read MANY autopsy reports to know what to look for specifically. As eating disorders became a more prevalent diagnosis in ICU, we could see most of these same results in our patients. Luckily, we had a very good survival and discharge rate. ( I'm not sure an eating disorder is ever truly and permanently cured. The potential for relapse due to triggers is very high).
Usually, the M.E. will simply state the things I have discussed as findings in the dissection and system review sections without comment as to cause.
So a person wondering if bulimia or anorexia was a problem may have to know what to look for in the wording.
I hope this helps.. I am so sorry for all who have taught me these things through their untimely deaths.
Fortunately, I think Phaedra will not remember this. I did read that her former nanny will be involved in raising the boys. I don't know how true that is, but I hope it is. Between her, their father and the boys paternal grandparents, I think they will be raised exactly how she wanted them to be. She had tweeted that Sir Bob doesn't see the boys, and said something like "well, that's his loss." (Her tweets are now protected, and her instagram is gone.)
