Reversible severe hepatitis in anorexia nervosa: a case report and overview.
Mildly elevated transaminases are often observed in anorexia nervosa patients, but severe hepatitis is less common. We suggest that hypoperfusion is the pathogenetic factor that causes severe hepatitis in a patient with a very poor nutritional status and present an overview of previous case reports. In our patient, early initiation of intravenous fluids resulted in rapid recovery of the liver test abnormalities, despite minimal oral caloric intake, the refusal of enteral feeding and the development of a hypoglycemic coma. Two months after admission, transaminases had normalized. Reversible severe hepatitis has been described in most of the cases, with only one anorexia nervosa-related fatal hepatitis. In general, both adequate hydration and gradual enteral feeding with monitoring of electrolytes are essential in the management of anorexia patients with severe hepatitis.
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Dewkoemar
D
Ramsoekh
Pavel
P
Taimr
Thomas
T
Vanwolleghem
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000856:Anorexia Nervosa / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D004796:Clinical Enzyme Tests; D004750:Enteral Nutrition; D005260:Female; D005440:Fluid Therapy; D006505:Hepatitis / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008111:Liver Function Tests; D009752:Nutritional Status; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D000410:Alanine Transaminase