Severe acute liver damage in anorexia nervosa: two case reports

Area of Science:

• Hepatology
• Internal Medicine
• Psychiatry

Background:

• Anorexia nervosa is a severe eating disorder characterized by self-starvation and significant weight loss.
• Patients with anorexia nervosa often present with multiple medical complications, including endocrine, cardiovascular, and gastrointestinal disturbances.

Observation:

• Two female patients with severe restrictive anorexia nervosa and extremely low body mass indexes developed sudden, severe liver damage.
• Clinical presentation included hypotension, bradycardia, dry skin, acrocyanosis, and hypothermia, indicative of systemic hypoperfusion.
• Common causes of liver failure were excluded, suggesting an alternative etiology.

Findings:

• Therapeutic intervention involved immediate plasma volume support, progressive nutritional rehabilitation (parenteral or oral), and electrolyte supplementation (potassium, phosphorus) to prevent refeeding syndrome.
• Patients showed rapid improvement in liver enzymes and clinical symptoms following this treatment regimen.

Implications:

• The findings suggest that acute hypoperfusion, secondary to severe malnutrition and physiological compromise in anorexia nervosa, may be a primary cause of acute liver damage.
• This highlights the critical role of timely and aggressive nutritional and hemodynamic support in managing liver complications in anorexia nervosa.
• Early recognition and intervention are crucial for preventing potentially irreversible liver injury in patients with severe anorexia nervosa.