Abnormal Liver Function Tests in an Anorexia Nervosa Patient and an Atypical Manifestation of Refeeding Syndrome

Vootla, Vamshidhar; Daniel, Myrta

doi:10.1159/000437321

Cited by 7 publications

(4 citation statements)

References 12 publications

(11 reference statements)

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“…Increased lipofuscin deposition, as was seen in our case, has been reported in cases of anorexia nervosa (9); however, this may be a common finding in liver biopsies and offers little diagnostic information. Increased iron deposition, as was seen in this case, has also been described in cases of anorexia nervosa (9,13) and other forms of starvation (14). This is probably because protein deficiency causes a decrease in the substrate for hemoglobin synthesis and a reduced demand for iron in the body, leading to the accumulation of unused iron in the liver.…”

Section: Discussionsupporting

confidence: 81%

Starvation-induced Liver Enzyme Elevation after Initiation of Feeding

et al. 2019

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Exacerbation of liver enzymes after the initiation of feeding in malnourished patients is caused by refeeding syndrome or persistent starvation. There are no definite clinical markers for distinguishing between the two conditions. We herein report a 63-year-old woman with starvation-induced liver enzyme elevation. Her body weight was inversely associated with the liver enzyme levels after refeeding, which was a different course from refeeding syndrome. Normalization of liver enzymes ensued as the caloric intake increased and weight gain progressed. Daily changes in body weight can be a useful clinical marker for distinguishing between refeeding syndrome and starvation-induced liver enzyme elevation.

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Section: Discussionsupporting

confidence: 81%

Starvation-induced Liver Enzyme Elevation after Initiation of Feeding

et al. 2019

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“…Additionally, aminotransferase elevations in refeeding syndrome tends to be lower than aminotransferase elevations secondary to severe malnutrition, with ALT ranging from 193 IU/L to 218 IU/L and AST ranging from 157 IU/L to 173 IU/L, in case reports of transaminitis secondary to refeeding syndrome. 3,4 While refeeding syndromes are often associated with weight gain, our case demonstrates that patients with severe malnutrition may continue to lose weight even after supervised feedings have begun, placing them at continued risk for rising aminotransferases, liver failure, and complications of anorexia nervosa. In our patient, continued feeding with controlled enteral supplementation eventually led to a decline in transaminases as her weight increased.…”

Section: Discussionmentioning

confidence: 83%

Expanding the differential diagnosis for transaminitis in patients with anorexia nervosa

et al. 2016

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Aminotransferase elevations have been described in patients with anorexia nervosa. Hypothesized etiologies have included ischemic hepatitis, refeeding-induced transaminitis, and the process of autophagy. Supervised enteral nutrition is the mainstay of treatment for severe anorexia, but an increase in aminotransferase levels after initiation of enteral feeding presents clinicians with a diagnostic dilemma. We present a 31-year-old woman with anorexia nervosa (body mass index [BMI] of 13.5 kg/m) who experienced a worsening of aminotransferase elevations even after the initiation of enteral feeding. Despite nutritional supplementation, the patient's weight continued to fall for 6 days. Peak aminotransferase concentrations correlated with the patient's lowest weight and improved only after an increase in BMI was eventually achieved. Secondary causes of severe transaminitis were investigated, and after no cause was found, a liver biopsy was performed. Pathology was consistent with liver injury secondary to severe malnutrition rather than from refeeding syndrome. This case highlights malnutrition as an important cause of aminotransferase elevations and underscores the need for judicious early weight restoration in patients with anorexia and abnormal liver chemistry.

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“…Hepato-cellular injury can occur due to the triggers of malnutrition such as apoptosis, autophagy, hypoperfusion of liver, oxidative stress & hypoxia 3 . It is common to have dry skin in patients with nutritional deprivation 1 .…”

Section: Consequences Of Anorexiamentioning

confidence: 99%

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2022

IJPSR

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Anorexia nervosa (AN) is a life-threatening condition with the highest mortality rate of all psychiatric disorders. The core physiological features of ANare the extreme overvaluation of shape and weight. Severe AN causes cardiovascular complications and majorly refeeding syndrome. The prominent features of refeeding syndrome include severe hypophosphatemia, hypokalemia and hypomagnesia, and other fluid imbalance abnormalities, vitamin deficiencies, volume overload, and edema. Most cases are brought to clinical attention only when there are severe somatic complaints. According to the Global Leadership Initiative on Malnutrition (GLIM) classification, the patients with AN present chronic disease-related malnutrition without inflammation with different degrees of severity. To be diagnosed with anorexia nervosa a person must meet all of the current DSM 5 criteria. We cannot pinpoint a single cause for anorexia nervosa. It is caused by the complex interaction of various genetic and psychosocial factors, other risk factors include: stress, social isolation, poor emotion regulation strategies, and general psychiatric co-morbidities. In anorexia, Nutritional supplements can improve weight gain, which can reverse the abnormal hematological factors, dermatological factors, bradycardia & abnormal liver enzymes. Although nutritional rehabilitation is an essential component of the physical treatment of anorexia nervosa, psychological treatment is also necessary to address the anxiety issues of the patient.

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Abnormal Liver Function Tests in an Anorexia Nervosa Patient and an Atypical Manifestation of Refeeding Syndrome

Cited by 7 publications

References 12 publications

Starvation-induced Liver Enzyme Elevation after Initiation of Feeding

Starvation-induced Liver Enzyme Elevation after Initiation of Feeding

Expanding the differential diagnosis for transaminitis in patients with anorexia nervosa

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