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Hypoglycemia and death in anorexia nervosa
1Department of Psychiatry, Massachusetts General Hospital, Boston.
Psychotherapy and Psychosomatics
|January 1, 1987
Summary
Life-threatening hypoglycemia can occur in severe anorexia nervosa. Prompt glucose administration can reverse coma, but the underlying mechanisms require further investigation.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Nutritional Science
Background:
- Anorexia nervosa (AN) is an eating disorder characterized by severe malnutrition and cachexia.
- Deaths in AN are often attributed to inanition, but the precise mechanisms remain unclear.
- Life-threatening hypoglycemia is a rare but serious complication of AN.
Observation:
- Two severely cachectic women with anorexia nervosa presented with coma and profound hypoglycemia (serum glucose 8 and 14 mg/dl).
- Both patients regained consciousness following intravenous glucose administration.
- Pneumonia was diagnosed in both patients concurrently with the hypoglycemic events.
Findings:
- This case series highlights a potential link between severe malnutrition in AN, infection, and hypoglycemia.
- The proposed mechanism involves suppressed gluconeogenesis due to infection, compounded by depleted fat stores and reduced catecholamine release in AN.
- This suggests a complex interplay of factors contributing to hypoglycemia in advanced AN.
Implications:
- Recognizing and managing hypoglycemia is critical in severely ill anorexia nervosa patients.
- Further research is needed to elucidate the pathophysiology of hypoglycemia in AN.
- These findings underscore the importance of metabolic monitoring and prompt intervention in patients with severe anorexia nervosa.