title: Metabolic and neurologic sequelae in a patient with long-standing anorexia nervosa who presented with septic shock and deep hypoglycemia.
abstract: OBJECTIVE
  To report the case of a 48-year female with chronic remitting anorexia nervosa who was found comatose at home and admitted to our hospital with a deep hypoglycemia (glucose level 0.6 mmol/L; 11 mg/dL) and septic shock secondary to a bilateral pneumonia.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  After admission to the critical care unit, she further displayed a number of pronounced complications known to be associated with anorexia, including hypophosphatemia, disturbed liver functions and depression of all three hematological cell lines. The neurological recovery of the patient was complicated by encephalopathy and transient tetraparesis. With initial deep hypoglycemia at presentation and persisting coma, magnetic resonance imaging performed 5 days later did not demonstrate characteristic post-hypoglycemic abnormalities. Neuroradiological examination did however reveal the presence of extensive calcifications in the basal ganglia known as Fahr's syndrome.
  
  
  CONCLUSIONS
  The potential relation between anorexia nervosa and Fahr syndrome has not been described before. The fact that this patient survived a glucose level that is usually associated with a very poor outcome is probably related to its special origin.
authors.affiliation: Department of Critical Care, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, the Netherlands.
authors.forename: Corine M
authors.initials: CM
authors.lastname: de Jager
authors.forename: Miriam
authors.initials: M
authors.lastname: Hoekstra
authors.forename: Maarten W N
authors.initials: MW
authors.lastname: Nijsten
authors.forename: Annemieke Oude
authors.initials: AO
authors.lastname: Lansink
authors.forename: Farouq
authors.initials: F
authors.lastname: Ismael
mesh_terms: D000856:Anorexia Nervosa / Q000150:complications* / Q000378:metabolism; D001480:Basal Ganglia Diseases / Q000209:etiology; D001786:Blood Glucose / Q000032:analysis; D002114:Calcinosis / Q000209:etiology; D003128:Coma / Q000209:etiology* / Q000378:metabolism; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology* / Q000378:metabolism; D008875:Middle Aged; D012772:Shock, Septic / Q000209:etiology* / Q000378:metabolism
chemical_list: D001786:Blood Glucose