Contaldo F, Di Paolo M R, Mazzacano C, Di Biase G, Giumetti D
Cattedra di Scienza dell'Alimentazione, Facoltà di Scienze M.F.N., Università, Lecce.
Recenti Prog Med. 1990 Apr;81(4):266-8.
Patient L.A. (f., 20 yrs), affected by bulimia and self-induced vomiting, was hospitalized because of severe malnutrition (BMI 13.1), hypopotassemia (2.8 mEq/l) and prolonged QTc interval (0.469"). Intensive care treatment aimed to normalize mineral balance mainly serum potassium, consisted of administering e.v. potassium (mg 2346/day), magnesium (mg 72/day), calcium (mg 80/day), phosphorus (mg 769/day), chloride (mg 710/day), iron (mg 40/day). Dietary treatment was deliberately chosen to be slightly above minimum energy requirements in order to avoid possible side effects of forced hyperalimentation. The patient, immediately after hospitalization, interrupted vomiting and 2 wks later weight increased by 5 kg (from 34.9 kg to 40.0 kg). On the other hand normalization of serum potassium levels was slow and QTc interval reached normal range only after the 10th day of treatment (0.447"). This case supports the hypothesis that major ECG abnormalities may be present in severe malnutrition due to anorexia nervosa or bulimia with self-induced vomiting. The dangers of these complications were substantiated by the fact that intensive care treatment allowed prompt body weight recovery but normalization of electrolytic balance and cardiac function was very slow. For such patients, electrocardiographic monitoring should be routine.
患者L.A.（女性，20岁），患有神经性贪食症且有自我催吐行为，因严重营养不良（体重指数13.1）、低钾血症（2.8毫当量/升）和QTc间期延长（0.469秒）而住院。重症监护治疗旨在使矿物质平衡正常化，主要是血清钾，包括静脉注射钾（2346毫克/天）、镁（72毫克/天）、钙（80毫克/天）、磷（769毫克/天）、氯（710毫克/天）、铁（40毫克/天）。饮食治疗特意选择略高于最低能量需求，以避免强制过度营养可能产生的副作用。患者住院后立即停止呕吐，两周后体重增加了5千克（从34.9千克增至40.0千克）。另一方面，血清钾水平的正常化过程缓慢，QTc间期直到治疗第10天才达到正常范围（0.447秒）。该病例支持这样的假设，即严重营养不良可能因神经性厌食症或伴有自我催吐行为的神经性贪食症而出现主要心电图异常。重症监护治疗能使体重迅速恢复，但电解质平衡和心脏功能的正常化非常缓慢，这证实了这些并发症的危险性。对于此类患者，心电图监测应成为常规操作。
