[Anorexia nervosa--the views of the internist]

From the metabolic aspect anorexia nervosa is long-term incomplete starvation, sometimes interrupted by bulimic periods. Biochemical investigations reveal a differentiated protein catabolism, a decrease of protein carriers, enzymes, hormones, changes of minerals and their reserves, metabolic acidosis, a reduced plasma protein formation and other changes. As to psychic changes, behavioural abnormalities are found as well as altered attitudes and possibly also a more marked psychiatric symptomatology. The objective of the investigation was to test the extent and depth of metabolic changes and their possible improvement during intense metabolic care; permanent care of a clinical psychologist formed part of the treatment.

In five patients, age 17-44 years, height 155-170 cm, body weight on admission 29-42 kg with the clinical diagnosis of anorexia nervosa the following most marked metabolic changes were revealed: a low basal energy expenditure (range 4367-5468 kJ) calculated for fasting (3057-3828 kJ), reduced energy reserves of sugars, fats and protein, reduced total protein values (48-68 g/l), serum albumin (25-39 g/l); prealbumin (0.13-0.29 g/l), transferrin (1.2-2.59 g/l) and total cholesterol (five of six values were either at the lower borderline of normal values or reduced). The urinary N output per 24 hours was increased. After complete parenteral nutrition for 3-9 days (energy load increased from 150-190 kJ/kg body weight, amino acids from 30 to 60 g/day, and 50-100 ml 20% Nutralipid/day) and possible supplements the weight increment was 1.5-1.7 kg after 18-57 days in hospital. Throughout the hospital stay the patients were looked after by a psychologist. After returning home two patients developed a relapse.

Complete parenteral nutrition is an effective way of realimentation in anorexia nervosa. Psychological support is essential but it cannot prevent a relapse.