Potassium deficiency in anorexia nervosa, with reference to renal tubular vacuolation

Two cases of eating disorder revealed by the breakout of acute kidney injury after angiotensin II receptor blocker administration

Case 1: A 39-year-old woman with schizophrenia, obesity, hypertension and dyslipidemia was admitted to our hospital for deteriorating serum Cr level, from 97.2 to 645.3 µmol/l. She had been started on losartan 5 months earlier. After suspension of losartan and infusion of saline, her serum Cr level gradually recovered and she was discharged. Unfortunately, her physician restarted her on losartan, and 5 months after this discharge, her serum Cr level rose again to 194.5 μmol/l; again, serum Cr promptly recovered when losartan was discontinued. Self-induced vomiting after overeating, suggesting bulimia nervosa, was revealed via the detection of a remarkable reduction of chloride compared to sodium in her spot-urine sample. Case 2: A 39-year-old woman who had been diagnosed with bipolar disorder and diabetes mellitus was admitted to our hospital with suspected diabetic ketoacidosis. After improvement in her blood sugar level, olmesartan administration for hypertension was begun. Four days later, her serum Cr level had risen from 60.1 to 256.4 μmol/l. After suspension of olmesartan and infusion of saline, her serum Cr level gradually fell to normal levels. Urinalysis revealed the dissociation of sodium and chloride. During her hospitalization, habitual self-induced vomiting was discovered. The measurement of urinary electrolytes may be useful for the detection of eating disorders with self-induced vomiting; in these patients, the administration of angiotensin II receptor blockers may induce acute kidney injury.

Anorexia nervosa in males

Five cases of anorexia nervosa in males aged 13--23 years are described. Four patients presented to a general medical outpatient clinic with emaciation, and the fifth was diagnosed retrospectively. Sinus bradycardia was a useful pointer to the diagnosis, which was confirmed by the finding of characteristic psychopathological features of a relentless "pursuit of thinness", along with a fear of becoming obese.

Bulimia nervosa: an ominous variant of anorexia nervosa

Thirty patients were selected for a prospective study according to two criteria: (i) an irresistible urge to overeat (bulimia nervosa), followed by self-induced vomiting or purging; (ii) a morbid fear of becoming fat. The majority of the patients had a previous history of true or cryptic anorexia nervosa. Self-induced vomiting and purging are secondary devices used by the patients to counteract the effects of overeating and prevent a gain in weight. These devices are dangerous for they are habit-forming and lead to potassium loss and other physical complications. In common with true anorexia nervosa, the patients were determined to keep their weight below a self-imposed threshold. Its level was set below the patient's healthy weight, defined as the weight reached before the onset of the eating disorder. In contrast with true anorexia nervosa, the patients tended to be heavier, more active sexually, and more likely to menstruate regularly and remain fertile. Depressive symptoms were often severe and distressing and led to a high risk of suicide. A theoretical model is described to emphasize the interdependence of the various symptoms and the role of self-perpetuating mechanisms in the maintenance of the disorder. The main aims of treatment are (i) to interrupt the vicious circle of overeating and self-induced vomiting (or purging), (ii) to persuade the patients to accept a higher weight. Prognosis appears less favourable than in uncomplicated anorexia nervosa.

Anorexia nervosa: dietary treatment and re-establishment of body weight in 20 cases studied on a metabolic unit

This paper reviews the nutritional treatment and weight progress of 20 patients with anorexia nervosa studied in a teaching hospital metabolic unit between January 1974 and August 1977. The classification of patients, their pre-admission dietary intakes and weight status are compared. The method of re-establishing weight by closely monitored normal nutrition under conditions of bedrest and chlorpromazine medication are described. It is illustrated by the progress of one 14-year-old girl patient and the study of the rate of increase in weight of the whole group. Satisfactory weight levels were attained by all patients with acceptable time limits.

A controlled study of the EEG in anorexia nervosa

The nutritional disturbance in anorexia nervosa almost invariably leads to striking physiological changes, which include amenorrhoea, bradycardia, hypotension and relative hypothermia with reversal of the usual diurnal temperature rhythm (Bliss and Branch, 1960; Mayer-Grosset al., 1960; Crisp and Roberts, 1962; Crisp, 1967a). Crisp (1965a, 1967a) has commented on the characteristic and excessive alertness, restlessness and insomnia displayed by anorexia nervosa patients, whom he regards as showing a specific type of malnutrition associated with carbohydrate starvation. Russell (1967) has also recently demonstrated that patients with this illness restrict especially their carbohydrate intake.

Acute dilatation of the stomach in a patient with anorexia nervosa

It is generally believed that anorexia nervosa is due to an abnormal attitude of mind which results in an insufficient intake of food. As the term anorexia nervosa implies, many patients experience a loss of appetite, but sometimes this is not so, and vomiting is an alternative or additional device adopted by the patient to ensure a reduction in effective food intake. As a rule the patient induces vomiting by tickling her throat with her fingers, but sooner or later she becomes so proficient at vomiting that mechanical stimulation is no longer necessary. Nevertheless one should not assume that vomiting in anorexia nervosa is always under the control of the patient's will. In the patient described below vomiting became intractable and was found to be due to a physical disorder—acute dilatation of the stomach. Such a complication occurring in a severely undernourished patient is highly dangerous unless recognized early and treated effectively. The opportunity was taken to measure water absorption and gastric motility.