title: Elevated transaminases as a predictor of coma in a patient with anorexia nervosa: a case report and review of the literature.
abstract: BACKGROUND
  Liver injury is a frequent complication associated with anorexia nervosa, and steatosis of the liver is thought to be the major underlying pathology. However, acute hepatic failure with transaminase levels over 1000 IU/mL and deep coma are very rare complications and the mechanism of pathogenesis is largely unknown.
  
  
  METHODS
  A 37-year-old Japanese woman showed features of acute liver failure and hepatic coma which were not associated with hypoglycemia or hyper-ammonemia. Our patient's consciousness was significantly improved with the recovery of liver function and normalization of transaminase levels after administration of nutritional support.
  
  
  CONCLUSIONS
  Our case report demonstrates that transaminase levels had an inverse relationship with the consciousness of our patient, although the pathogenesis of coma remains largely unknown. This indicates that transaminase levels can be one of the key predictors of impending coma in patients with anorexia nervosa. Therefore, frequent monitoring of transaminase levels combined with rigorous treatment of the underlying nutritional deficiency and psychiatric disorder are necessary to prevent this severe complication.
authors.affiliation: Department of Gastroenterology, Internal Medicine, TMG Asakadai Central General Hospital, Saitama 351-8551, Japan. syoshida@bidmc.harvard.edu.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Yoshida
authors.forename: Masahiko
authors.initials: M
authors.lastname: Shimada
authors.forename: Miroslaw
authors.initials: M
authors.lastname: Kornek
authors.forename: Seong-Jun
authors.initials: SJ
authors.lastname: Kim
authors.forename: Katsunosuke
authors.initials: K
authors.lastname: Shimada
authors.forename: Detlef
authors.initials: D
authors.lastname: Schuppan