title: Severe acute liver damage in anorexia nervosa: two case reports.
abstract: OBJECTIVE
  Two female patients (18 and 30 y old, body mass indexes 14.1 and 13.2 kg/m2) with severe, restrictive anorexia nervosa developed sudden severe liver damage. In addition to overt protein-energy malnutrition, they showed marked hypotension, bradycardia, dry skin, acrocyanosis, and hypothermia. Most common causes of liver failure, such as hepatotropic viruses, hepatotoxic drugs, alcohol, cannabis, and cocaine abuse, were excluded.
  
  
  METHODS
  Therapeutic intervention consisted of immediate plasma volume support, progressive parenteral or oral nutritional rehabilitation, and parenteral potassium and phosphorus supplements to avoid the refeeding syndrome.
  
  
  CONCLUSIONS
  Improvement of initial clinical symptoms and rapid recovery of liver enzymes after this type of treatment suggest that severe liver damage in anorexia nervosa may be secondary to acute hypoperfusion.
authors.affiliation: Interuniversity Center for Obesity and Eating Disorders, Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: De Caprio
authors.forename: Alessia
authors.initials: A
authors.lastname: Alfano
authors.forename: Ignazio
authors.initials: I
authors.lastname: Senatore
authors.forename: Luigi
authors.initials: L
authors.lastname: Zarrella
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Pasanisi
authors.forename: Franco
authors.initials: F
authors.lastname: Contaldo
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000150:complications* / Q000628:therapy; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000378:metabolism; D008107:Liver Diseases / Q000209:etiology* / Q000628:therapy; D018529:Nutritional Support / Q000379:methods*; D010758:Phosphorus / Q000008:administration & dosage; D010953:Plasma Volume / Q000502:physiology; D011188:Potassium / Q000008:administration & dosage; D011502:Protein-Energy Malnutrition / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D010758:Phosphorus; D011188:Potassium