Secondary Renal and Respiratory Failure Caused by Chronic Surreptitious Vomiting and Laxative Abuse

Abstract

A 45-year-old woman had suffered from anorexia nervosa (AN) and bulimia nervosa (BN) since she was 18-years old, but had few medical or psychological treatment until she developed osteomalacia and gait disturbance seven years after onset. Diagnosis of AN and BN had been confirmed and patient had been admitted to the hospital and behavior therapy with general psychotherapy was started. A subsequent 3-year hospitalization led to minimal symptomatic recovery. Twelve years after discharge she was readmitted to the hospital due to shortness of breath complicated by a mixed metabolic acid-base disturbance, chronic renal failure and left renal atrophy. The clinical data suggested that the patient's kidney failed to compensate for the rise in blood pH because of hypokalemic nephropathy. A central respiratory disturbance developed (PCO_2 > 55 mmHg) to compensate for the existing metabolic alkalosis.