A case of anorexia nervosa with disseminated intravascular coagulation syndrome

Abstract

A 36-year-old Japanese woman with anorexia nervosa (AN) was admitted to our department because of severe emaciation. Although we were thorough in her clinical management and were careful to avoid precipitating refeeding syndrome, disseminated intravascular coagulation (DIC) developed 3 weeks after hospitalization. We treated her for DIC with sepsis using anticoagulants, protease inhibitors, antithrombin, and platelet concentrate transfusion. To treat her bacterial infection, we administered antimicrobial drugs and immunoglobulin. We began probiotic and prebiotic (synbiotics) treatment for bacterial translocation. We think that the prevention of sepsis via bacterial translocation is an important aspect of care for patients with severe AN in addition to the prevention of refeeding syndrome.

Diamine oxidase activity levels in anorexia nervosa

“…Furthermore, the possibility of damage to the intestinal barrier, as indicated by the low serum DAO activity levels, might reflect increased risk of bacterial translocation 14 in AN patients with severe malnutrition. 3 Usami et al 15 reported that bacterial translocation occurs more readily when DAO activity is low. Thus, the measurement of serum DAO activity levels might be useful for evaluating risk of bacterial translocation in AN patients with severe malnutrition.…”

“…3 Usami et al 15 reported that bacterial translocation occurs more readily when DAO activity is low. 3 Usami et al 15 reported that bacterial translocation occurs more readily when DAO activity is low.…”

“…Subsequently, impaired absorption of nutrients and bacterial translocation may also occur. 3 In humans and rodents, diamine oxidase (DAO) is specifically localized to the apical end of mature villi with high activity 4,5 and its activity reflects the integrity and maturity of the small intestinal mucosa. 2 The main feature of AN patients, especially those with the AN restricting type (AN-R), is decreased oral food intake and nutrition.…”

“…In fact, systemic sepsis due to bacterial translocation has been previously reported in AN patients. 3 In humans and rodents, diamine oxidase (DAO) is specifically localized to the apical end of mature villi with high activity 4,5 and its activity reflects the integrity and maturity of the small intestinal mucosa. DAO activity increases in parallel with DAO activity in the villi of the small intestinal mucosa in maturing rats 4,6 and correlates with the severity of small intestinal mucosal lesions induced by anti-cancer drugs.…”

Comparison between enteral nutrition and intravenous hyperalimentation in patients with eating disorders: results from the Japanese diagnosis procedure combination database

“…No suicide cases were identified in our study, which was probably because the population included inpatients only. Few studies have suggested the possibility of sepsis-induced death in ED patients [16,17]. Furthermore, a previous review indicated that IVH was not associated with an increase in sepsis compared with EN [18].…”