Outpatient Analytic Assessment of Anorexia Nervosa — The Importance of Venous Blood Gases

Abstract

Objective: To evaluate serum biochemical parameters’ evolution, especially venous blood gas (VBG), in anorexia nervosa (AN), correlating with clinical parameters. Methods: Retrospective study including out-patient AN adolescents, between January 2014 and May 2017. Three evaluations were compared: t1) first consultation; t2) consultation with the lowest body mass index (BMI) z-score and t3) with the highest BMI z-score. Results: A total of 24 adolescents (87.5% females) were included, mean age of presentation of 14.9±1.7 years, onset of symptoms 6.4±3.2 months before the first visit. In t1, BMI z-score of -1.91±1.11 kg/m2 and ideal weight % of 84.3±9.2. Amenorrhea was present in 88%. In t2 the analytical alterations were: altered VBG in 100%, altered ferritin (72% elevated), altered thyroid function (53% with thyroxine decrease), dyslipidemia (31% elevation of high density lipoprotein, 25% hypercholesterolemia), elevation of urea (25%), elevation of alanine aminotransferase (14%), hypoglycemia (14%), anemia (9%). Respiratory acidosis was present in 91% in t1, 100% in t2 and 94% in t3. There was a significant decrease between t2 and t3 in mean pCO2 (57.2 versus 53.6 mmHg; p=0.009) and mean HCO3 (30.0 versus 28.8 mEq/L; p=0.023). Conclusions: Respiratory acidosis and increased ferritin were common in this group. Respiratory acidosis was the most frequent abnormality with significant pCO2 and HCO3 variation in the recovery phase. VBG should be considered in AN evaluation, once it seems to be important in assessing the severity of the disease and its subsequent follow-up.

Hypercapnia in hospitalized children and adolescents with anorexia nervosa as a predictive marker for readmission: a prospective study

“…One possible explanation is that our study was not limited to recently diagnosed participants, as half of the participants had been showing signs of AN for over a year before admission. The persistence of acid–base disorders is controversial, as some studies report that the anomalies disappear [ 22 , 63 ] while another state that they persist despite weight gain [ 64 ]. We hypothesize that respiratory muscle weakening, especially diaphragm performance, may play a role in evolving AN over the longer term.…”

Ferritin – novel uses of a well-known marker in paediatrics

“…The aetiology of this is uncertain. Starvation and life-threatening actions during AN causes laboratory changes [25]. Ferritin can be a biomarker of malnourishment rather than inflammation and may be used to guide the control of that condition.…”

“…Sepsis [10,[12][13][14][15] COVID-19 [17,18] Anorexia [23][24][25][26][27] Obesity [29][30][31][32] Metabolic syndrome [38,39] Diabetes mellitus [41,42] Kawasaki disease [43] sJIA [44] M. pneumoniae [50, 51] ↓ RLS, PLMS [54][55][56][57] Cerebral palsy [58][59][60] ADHD [65] Autism [66,67] Tourette syndrome [68,69] Febrile seizures [71][72][73][74][75] Left ventricular fractional shortening [81] Tuberculosis [83][84][85][86] ADHD -attention deficit hyperactivity disorder, PLMS -periodic limb movement in sleep, RLS -restless legs syndrome, sJIA -such as juvenile idiopathic arthritis…”

“Serum ferritin – a nutritional marker for Anorexia Nervosa?”

“…(1,2) Anorexia Nervosa (AN) has an estimated prevalence of 0.3 -2% in the general population, with a peak incidence between 13 and 18 years of age. (1,3,4) AN can affect any organic system, leading to severe complications due to malnutrition and weight change (5) . Most of these complications are reversible with nutritional recovery, (1) so the existence of biomarkers related to nutritional status are valuable to assess response treatment.…”