Over the following days, polyuria and hypotension were observed. Informed consent was obtained from the mother of the child for publication of this case report. 78 0 obj
endobj >> /D [177 0 R /FitR 0 538.799 612 538.799] << /D [172 0 R /FitR 0 528.719 612 528.719] <<
<< /D [178 0 R /FitR 0 471.299 612 471.299] 82 0 obj /D [168 0 R /FitR 0 735.345 612 735.345] /F4 196 0 R 21 0 obj
/CropBox [0 0 612 792] All Rights Reserved. Patients with AN typically consult physicians for secondary amenorrhoea or significant body weight loss in a short period of time [23]. 62 0 obj /F11 202 0 R AN was the most frequent cause of hospitalization within all ED and suicide attempt-related hospitalizations were most common among patients with AN [9]. << 61 0 obj /Rotate 0 >> /D [177 0 R /FitR 0 792 612 792] According to symptoms classification, the girl was diagnosed with severe hyponatremia, similar to evaluation based on serum sodium concentration (Table2) [20, 32]. << /I0 205 0 R
endobj >> >> /D [166 0 R /FitR 0 792 612 792] 179 0 obj /D [178 0 R /FitR 0 779.299 612 779.299] >> As the symptoms of bulimia begin to strengthen their hold on a patient, the urge to skip meals and purge often becomes stronger. /D [166 0 R /FitR 0 729.159 612 729.159] 74 0 obj /Annots [340 0 R 341 0 R 342 0 R 343 0 R 344 0 R 345 0 R 346 0 R]
>>
101 0 obj 172 0 obj /D [173 0 R /FitR 0 760.479 612 760.479] << /F0 192 0 R endobj /ProcSet [/PDF /ImageB /ImageC /ImageI /Text] 44 0 obj 175 0 obj /D [176 0 R /FitR 0 717.579 612 717.579] However, individuals with bulimia will typically drink large amounts of water for different reasons. /F5 197 0 R << >> >> /Resources << Hormonal disorders and renal damage were taken into consideration for the differential diagnosis of hyponatremia: the tests results were within reference values. >> /F10 309 0 R
590 0 R 591 0 R 592 0 R 593 0 R 594 0 R] >> >> >> /TrimBox [0 0 612 792] << Polydipsia and water intoxication in psychiatric patients: a review of the epidemiological literature.
/CropBox [0 0 612 792] /Resources << /Count 14 /Contents [657 0 R 658 0 R 659 0 R 660 0 R 661 0 R 662 0 R 663 0 R 664 0 R 665 0 R 666 0 R /A 681 0 R
<< endobj /Parent 12 0 R <<
>> /D [176 0 R /FitR 0 304.079 612 304.079] << 305 0 R 306 0 R 307 0 R 308 0 R] << /Resources << >> /D [166 0 R /FitR 0 404.16 612 404.16] 14 0 obj
/D [166 0 R /FitR 0 638.16 612 638.16] 130 0 obj /D [166 0 R /FitR 0 560.16 612 560.16] /D [166 0 R /FitR 0 300.16 612 300.16] /D [174 0 R /FitR 0 539.48 612 539.48] Laboratory testing revealed electrolyte imbalance (Table1). endobj
/I0 205 0 R /Contents [486 0 R 487 0 R 488 0 R 489 0 R 490 0 R 491 0 R 492 0 R 493 0 R 494 0 R 495 0 R 103 0 obj endobj The symptoms of hyponatremia may include nausea, vomiting, headache, confusion, somnolence, seizures and coma, as well as cardiorespiratory failure, all of which were observed in our case. /Parent 11 0 R 2016-9-22 /TrimBox [0 0 612 792] >> Long-term follow-up studies have confirmed two broad outcome groups with either a good outcome or chronic course with a high risk of death [4, 16]. We believe that this case report serves as a reminder of an important clinical lesson. stream AN has been recognised as an ED with one of the highest risks of a fatal outcome [24]. >> Fichter MM, Quadflieg N. Mortality in eating disordersresults of a large prospective clinical longitudinal study.
Cerebrospinal fluid (CSF) analysis excluded neuroinfection. /Rotate 0 They reported that their daughter had been on a weight-loss diet for few months and she had not menstruated for 6 months. /Resources << /MediaBox [0 0 612 792] /Contents [295 0 R 296 0 R 297 0 R 298 0 R 299 0 R 300 0 R 301 0 R 302 0 R 303 0 R 304 0 R The data presented in publications and from this case indicate that the amount of fluids consumed by patients with AN have to be monitored, both at hospital and at home.
/F1 193 0 R /Producer <5044466C69622B50444920382E302E3270312028432B2B2F57696E3634293B206D6F646966696564207573696E6720695465787453686172709220352E352E3320A9323030302D323031342069546578742047726F7570204E5620284147504C2D76657273696F6E29> endobj /D [175 0 R /FitR 0 643.479 612 643.479] 36 0 obj
79 0 obj ,KygL*P{%B2tQ-SFAL
endobj 83 0 obj Various pathomechanisms in anorexia patients leading to fluid imbalanced were noticed: releasing of antidiuretic hormone and osmoregulation disorders; deficiency in cell volume regulatory mechanisms and abate glomerular filtration rate [29]. Zieg J. 477 0 R 478 0 R 479 0 R 480 0 R 481 0 R 482 0 R 483 0 R 484 0 R 485 0 R] Due to the fast progress of the symptoms, including loss of consciousness, she was referred to the Pediatric Intensive Care Unit (PICU). << 615 0 R 616 0 R 617 0 R 618 0 R 619 0 R 620 0 R 621 0 R 622 0 R 623 0 R 624 0 R /Resources <<
<<
(Rpone.0163574.ref009) 87 0 R (Rpone.0163574.ref010) 88 0 R (Rpone.0163574.ref011) 89 0 R (Rpone.0163574.ref012) 90 0 R (Rpone.0163574.ref013) 91 0 R /F0 192 0 R
endobj Bahia A, Chu E, Mehler P. Polydipsia and hyponatremia in a woman with anorexia nervosa. 1). showed that death is most often secondary to medical complications of starvation (50%) or suicide (50%) [19]. /A 682 0 R /D [177 0 R /FitR 0 388.299 612 388.299]
155 0 obj << /MediaBox [0 0 612 792] Physical examination revealed conjunctival petechiae and thin subcutaneous tissue; body weight was 45 kg (25c), body height 170 cm (97c), and BMI was 15.57 (3c). /D [168 0 R /FitR 0 310.079 612 310.079] Swelling in the cheeks and jaw can also be caused by irritation to the salivary glands in those areas. /TrimBox [0 0 612 792] 109 0 obj /F13 322 0 R
>> sharing sensitive information, make sure youre on a federal
/D [166 0 R /FitR 0 792 612 792] De Leon J, Verghese C, Tracy JI, Josiassen RC, Simpson GM. /Names [(Lpone.0163574.ref034) 45 0 R (Lpone.0163574.ref035) 46 0 R (Lpone.0163574.ref038) 47 0 R (Lpone.0163574.ref039) 48 0 R (Lpone.0163574.ref040) 49 0 R In the course of the disease, numerous organ complications may develop, depending on the disease stage and severity of cachexia [14]. 256 0 R 257 0 R 258 0 R 259 0 R 260 0 R 261 0 R 262 0 R] >> >> >> <<
/Font << (Lpone.0163574.ref041) 50 0 R (Lpone.0163574.ref042) 51 0 R (Lpone.0163574.ref043) 52 0 R (Lpone.0163574.ref044) 53 0 R (Lpone.0163574.ref045) 54 0 R /ProcSet [/PDF /ImageB /ImageC /ImageI /Text] /F5 197 0 R shown that physiological effects of starvation and purging behaviors were responsible for over half of deaths resulting from medical complications of AN [17].
>> 6 0 obj
<< /D [174 0 R /FitR 0 669.479 612 669.479] >> Although enteral nutrition is an essential life-saving treatment in severe cases of AN, it does not guarantee long-term success or recovery [34]. << /XObject <<
endobj >> /F2 194 0 R
<< /Font <<
95 0 obj 655 0 R 656 0 R] << /Metadata 2 0 R endobj National populationbased data on the incidence, prevalence, and psychiatric comorbidity of eating disorders in Taiwanese adolescents and young adults. HUKS@VbZ(q#ZJqS. >> << >> << There are two subtypes of AN: a restricting type and a binge-eating/purging type [5]. Young age and female hormones are the major risk factors for the development of hyponatremic encephalopathy. >> /Annots [263 0 R 264 0 R 265 0 R 266 0 R 267 0 R 268 0 R 269 0 R 270 0 R 271 0 R 272 0 R << endobj <<
<< 118 0 obj >> /D [177 0 R /FitR 0 792 612 792] This can include turning down specific types of food and entire meals because they are particularly concerned with how it will affect their weight.
97 0 obj
/Subtype /XML Her prior medical history revealed that she had experienced persistent vomiting and had complained of a headache 2 days before hospital admission.
144 0 obj /Length 4809 Review of the worldwide epidemiology of eating disorders. /BS << /Resources << /F0 192 0 R >>
<< >> 146 0 obj endobj endobj Although the background of polydipsia in patients with AN may vary, the most common reasons include a willingness to suppress hunger and eliminate toxins from the body. However, as patients continue to have extreme thirst, they eventually drink beyond the kidneys capacity to dilute urine, resulting in hyponatremia [22]. << f-{![~3Q(p9gsi/Hs(at=2AmP(Ks-p.4\]HLo\Llb\Nz{4\y8~xSukTp sN#-K+%Ls9sxpgK'O7GU;,|>U9RwDpM45tD[:X([X!kQ/'2l N>_(
/Rotate 0 << endstream << <<
endobj Prevalence, comorbidities and outpatient treatment of anorexia and bulimia nervosa in German children and adolescents. endobj >> endobj
/D [168 0 R /FitR 0 784.345 612 784.345] /Kids [165 0 R 166 0 R 167 0 R 168 0 R 169 0 R 170 0 R 171 0 R 172 0 R 173 0 R 174 0 R] << AN can affect every organ system: cardiovascular, gastrointestinal, electrolytes, endocrine, bone, renal, hematologic, pulmonary, neurologic, and psychiatric and cause many medical complications [7]. /ProcSet [/PDF /ImageB /ImageC /ImageI /Text] endobj endobj << /D [176 0 R /FitR 0 573.079 612 573.079] >> uuid:e49d82f2-77ce-44cd-9418-38f5c9439772 /Parent 11 0 R << 94 0 obj /D [166 0 R /FitR 0 300.16 612 300.16] /D [166 0 R /FitR 0 456.16 612 456.16] /F13 322 0 R /D [166 0 R /FitR 0 677.159 612 677.159] endobj /Title (The Water Load Test As a Measure of Gastric Interoception: Development of a Two-Stage Protocol and Application to a Healthy Female Population) endobj /CreationDate (D:20160917135926+05'30')
/Length 759 << >> endobj << /F15 360 0 R In patients suspected of consuming greater amounts of fluids, periodical tests for serum sodium levels are necessary to detect hyponatremia as soon as possible, and to prevent its life-threatening consequences.
