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Objective To report a case of severe multisystem illness, near death and permanent kidney failure in a woman with a history of anorexia nervosa-binge purge type due to abuse of prescription metformin, an approved oral diabetes medication obtained surreptitiously via the internet. Method Psychiatric and medical records were reviewed from the medical care of this patient. A literature search was also performed on prescription medication abuse as a mode of purging. Discussion Metformin abuse in a patient with an eating disorder as a purging behavior is a rarely reported, albeit very dangerous entity. Clinicians treating eating disorders should increasingly be aware of the potential abuse of prescription medications, unapproved for weight loss but which have weight loss, as a reported side effect. This is particularly important as the ability to obtain prescription medications via the internet, without a prescription, becomes more ubiquitous.

Patients with anorexia nervosa often voice a multitude of symptoms in regards to their gastrointestinal tract. These complaints can complicate the treatment of their eating disorder as they distract attention from the important goal of weight restoration. Moreover, the restricting of certain food groups also makes the task of weight restoration substantially more difficult, or may result in binging. Therefore a working knowledge of common gastrointestinal comorbidities, such as celiac disease, irritable bowel syndrome, inflammatory bowel disease, and gastroparesis, is useful when treating a patient who has anorexia nervosa.