title: To the limit of extreme malnutrition.
abstract: Extreme malnutrition with body mass index (BMI) as low as 10 kg/m(2) is not uncommon in anorexia nervosa, with survival enabled through complex metabolic adaptations. In contrast, outcomes from hunger strikes and famines are usually fatal after weight loss to about 40% below expected body weight, corresponding to BMI 12 to 13 kg/m(2) in adults. Thus, many years of adaptation in adolescent-onset anorexia nervosa, supported by supplements of vitamins and treatment of intercurrent diseases, may allow survival at a much lower BMI. However, in the literature only a few cases of survival in patients with BMI <9 kg/m(2) have been described. We report on the case of a 29-y-old woman who was successfully treated in a specialized unit. She had a BMI of 7.8 kg/m(2). To our knowledge, this level of extreme malnutrition has not previously been reported. The present case emphasizes the importance of adherence to guidelines to decrease refeeding complications.
authors.affiliation: Centre for Eating Disorders, Department of Endocrinology, Odense University Hospital, Odense, Denmark. Electronic address: Jacob.froelich@rsyd.dk.
authors.forename: Jacob
authors.initials: J
authors.lastname: Frølich
authors.affiliation: Centre for Eating Disorders, Department of Endocrinology, Odense University Hospital, Odense, Denmark.
authors.forename: Camilla Viola Buskbjerg
authors.initials: CV
authors.lastname: Palm
authors.affiliation: Centre for Eating Disorders, Department of Endocrinology, Odense University Hospital, Odense, Denmark.
authors.forename: Rene K
authors.initials: RK
authors.lastname: Støving
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000150:complications*; D015992:Body Mass Index; D001835:Body Weight; D005260:Female; D006801:Humans; D044342:Malnutrition / Q000178:diet therapy / Q000209:etiology*; D055677:Refeeding Syndrome / Q000517:prevention & control; D012720:Severity of Illness Index
keywords: Anorexia nervosa; Eating disorder; Refeeding syndrome