Alvin P, Zogheib J, Rey C, Losay J
Travail du Service de Médecine pour Adolescents, Département de Pédiatrie, C.H.U. Bicêtre, Le Kremlin-Bicêtre.
Arch Fr Pediatr. 1993 Nov;50(9):755-62.
Subclinical medical complications frequently occur during the follow-up of anorexia nervosa and bulimia. This paper describes some of these.
Charts of 99 adolescent patients (89 girls and 10 boys), aged 11.8 to 22 years (mean: 16.6 +/- 2.1 years), admitted for anorexia nervosa (N:92) or bulimia (N:7), were analyzed retrospectively. All severe or potentially severe, clinical and non-clinical, findings at admission were included in the study.
Anorexic patients had a mean weight loss of 31.5% (22 of them were also vomiters or laxative abusers). Initial nasogastric tube feeding was necessary in 19 patients and parenteral nutrition in 2. Bradycardia and hypotension were common. A variety of ECG abnormalities were seen in 86% of the patients. Mitral valve prolapse was present in 14 of the 43 patients examined by echocardiography. Electrolyte imbalance was also common: hyponatremia in 7 patients, hypokalemia in 21, hypochloremia in 10 of the 12 vomiters, hypophosphatemia in 7, hyperazotemia in 24 and hypoglycemia in 22. Bone marrow hypoplasia was frequent, with leukopenia in 29 patients, anemia in 21 and thrombocytopenia in 5. No patient developed infectious complications. One patient presented with an acute gastric dilatation and another with spontaneous pneumomediastinum. One patient, 14 year-old, died 3 years after the onset of anorexia from acute water intoxication.
These well-known complications are more common in anorexic than in bulimic patients. Their prevention requires rigorous and continuous medical supervision.
在神经性厌食症和贪食症的随访过程中，亚临床医疗并发症经常出现。本文描述了其中的一些并发症。
对99例年龄在11.8至22岁（平均：16.6±2.1岁）的青少年患者（89名女孩和10名男孩）的病历进行回顾性分析，这些患者因神经性厌食症（n = 92）或贪食症（n = 7）入院。研究纳入了所有入院时严重或潜在严重的临床和非临床检查结果。
厌食症患者平均体重减轻31.5%（其中22人还伴有呕吐或滥用泻药）。19例患者需要初始鼻饲管喂养，2例需要肠外营养。心动过缓和低血压很常见。86%的患者出现各种心电图异常。在接受超声心动图检查的43例患者中，14例存在二尖瓣脱垂。电解质失衡也很常见：7例低钠血症，21例低钾血症，12例呕吐患者中有10例低氯血症，7例低磷血症，24例高氮血症，22例低血糖。骨髓发育不全很常见，29例患者白细胞减少，21例贫血，5例血小板减少。没有患者发生感染性并发症。1例患者出现急性胃扩张，另1例出现自发性纵隔气肿。1例14岁患者在厌食症发病3年后死于急性水中毒。
这些众所周知的并发症在厌食症患者中比在贪食症患者中更常见。预防这些并发症需要严格且持续的医学监测。
