66

66 CASE 66


A 16-year-old girl is brought to a physician by her parents because of the patient’s dramatic weight loss.


The patient dances 4 days a week at a private studio. During the past 2 months, she has not been interested in eating and now is weak and unable to complete the dance regimens. Her last menstrual period was 4 months ago.



PHYSICAL EXAMINATION



VS: T 35.5°C, P 55/min, R 15/min, BP 90/66 mm Hg, BMI 15

PE: The patient is thin with minimal subcutaneous fat stores. Leg muscles are well toned, but arm and upper body muscles are weak. Complexion is pale, and capillary refill after compression of a finger nailbed is slow. The patient denies that there is any problem.


LABORATORY STUDIES



Pregnancy test: Negative

Hemacrit: 32% (normal: 36-46%)


DIAGNOSIS


Starvation (anorexia nervosa)



PATHOPHYSIOLOGY OF KEY SYMPTOMS


This patient’s symptoms are due to a negative caloric balance maintained for a long duration. Caloric restriction causes the loss of energy substrates, with depletion first of carbohydrates and then adipose and finally catabolism of muscle (Fig. 66-1). Blood pressure and body temperature fall, and the hypotension, combined with anemia, causes a pale complexion and slow capillary refill.


image

FIGURE 66–1 Effect of starvation on the food stores of the body.

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Jul 4, 2016 | Posted by in PHYSIOLOGY | Comments Off on 66

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