Frequent purging behavior of any kind can produce fluid and electrolyte abnormalities, most frequently hypokalemia, hyponatremia, and hypochloremia. The loss of stomach acid through vomiting may produce a metabolic alkalosis (elevated serum bicarbonate), and the frequent induction of diarrhea through laxative abuse can cause metabolic acidosis. Some individuals with Bulimia Nervosa exhibit mildly elevated levels of serum amylase, probably reflecting an increase in the salivary isoenzyme.