Metabolic and neurologic sequelae in a patient with long-standing anorexia nervosa who presented with septic shock and deep hypoglycemia

Abstract

The potential relation between anorexia nervosa and Fahr syndrome has not been described before. The fact that this patient survived a glucose level that is usually associated with a very poor outcome is probably related to its special origin.

MECHANISMS IN ENDOCRINOLOGY: Anorexia nervosa and endocrinology: a clinical update

“…Sudden unexpected death is still well described among young women with AN, and manifest hypoglycemia was recognized as the cause of death in some of these fatal cases (37). Hypoglycemic coma in AN can be refractory or repetitive, so that continuous glucose administration is required to maintain euglycemia (38, 39, 40, 41, 42). The incidence of asymptomatic or subclinical hypoglycemia is unknown.…”

Metabolic and Nutritional Needs to Normalize Body Mass Index by Doubling the Admission Body Weight in Severe Anorexia Nervosa

“…We initially prescribed a caloric intake higher than recommended by the other authors, because we believe that such extremely undernourished patients need a supply no less than the measured REE, 30.2 kcal/kg/day in our patient 14,25. If the amount still recently suggested by some authors,22 10 kcal/kg/day, had been started with some major and fatal complications of undernutrition would have very probably appeared 26–28…”

“…14,25 If the amount still recently suggested by some authors, 22 10 kcal/kg/day, had been started with some major and fatal complications of undernutrition would have very probably appeared. 26–28…”

Rare medical manifestations of severe restricting and purging: “Zebras,” missed diagnoses, and best practices

“…In AN, it arises from swallowing muscle weakness related to starvation‐mediated muscular atrophy, and concurrent GERD may worsen the problem. The risk from undiagnosed and untreated dysphagia is that a patient may aspirate—that is, swallow oral contents fully into the lungs, often the right middle or right lower lobe—and develop a bacterial pneumonia that could become life‐threatening . Not every patient with dysphagia has the same degree of swallow dysfunction on testing.…”

“…The risk from undiagnosed and untreated dysphagia is that a patient may aspiratethat is, swallow oral contents fully into the lungs, often the right middle or right lower lobe-and develop a bacterial pneumonia that could become life-threatening. [17][18][19][20] Not every patient with dysphagia has the same degree of swallow dysfunction on testing. That is, some patients who express difficulties in swallowing are found actually to have normal swallowing abilities, others have moderately abnormal swallowing, in which food or liquid enters the airway but remains above the vocal folds (called penetration), while others have frank aspiration, where food or liquid actually passes beyond the vocal folds into the lungs.…”