Bridet Lionel, Martin Juan Jose Beitia, Nuno Jose Luis Cabriada
Department of Gastroenterology, Hospital Galdakao-Usansolo, Galdakao, Spain.
Turk J Gastroenterol. 2014 Apr;25(2):205-8. doi: 10.5152/tjg.2014.2531.
Anorexia nervosa is an eating disorder predominantly affecting young women and characterized by an intense fear of gaining weight and becoming fat. Liver injury with mild elevation of hepatic enzymes is a frequent complication, and steatosis of the liver is thought to be the major underlying pathology. However, acute hepatic failure with transaminase levels over 1000 u/L is a very rare complication, and the precise mechanism of the liver injury is still unclear. We report a case of a 35-year-old woman with a history of anorexia nervosa who developed acute liver damage with deep coma in relation to profound hypoglycemia. The treatment was hydration, correction of electrolyte and fluid imbalance, and gradual nutritional support to prevent refeeding syndrome. Our patient's consciousness was significantly improved with the recovery of liver function and normalization of transaminase levels. Although the mechanism of pathogenesis is largely unknown, we discuss the two principal hypotheses: starvation-induced autophagy and acute hypoperfusion.
神经性厌食症是一种主要影响年轻女性的饮食失调症，其特征是强烈害怕体重增加和变胖。肝酶轻度升高的肝损伤是常见并发症，肝脏脂肪变性被认为是主要潜在病理。然而，转氨酶水平超过1000 u/L的急性肝衰竭是非常罕见的并发症，肝损伤的确切机制仍不清楚。我们报告一例35岁有神经性厌食症病史的女性，因严重低血糖发生急性肝损伤并深度昏迷。治疗方法为补液、纠正电解质和液体失衡以及逐步给予营养支持以预防再喂养综合征。随着肝功能恢复和转氨酶水平正常化，我们患者的意识明显改善。尽管发病机制在很大程度上尚不清楚，但我们讨论了两个主要假说：饥饿诱导的自噬和急性低灌注。
