A Case of Anorexia Nervosa with Repeated Episodes of Hypoglycemic Coma

Abstract

An episode of hypoglycemic coma in anorexia nervosa (AN) is rare. We herein reported a 18-year-old woman, a high school student, with a 3-year history of AN who showed hypoglycemic coma episodes 2 times during her hospitalization. The patient was admitted to our hospital due to the mental disturbance. Physical examinations showed a coma (JCS III- 100) , severe emaciation (body height : 163.0 cm, body weight : 25.0 kg), low body temperature (35.0℃ and mild anemia. The laboratory data on admission revealed low levels of plasma glucose (15 mg/dl) and triglyceride (3 mg/dl), an increase in transaminase levels (GOT 1,491 IU/l, GPT 2,546 IU/l) and mild pancytopenia in the peripheral blood. Plasma insulin level was low (3 μU/ml), although the counter-regulatory hormones were over than normal upper limits. No evidence of insulinoma in the pancreas, general inflammatory signs and hepatitis -associated viral infections was observed. Mental level recovered soon after intravenous injection with glucose. Intravenous hyperalimentation stopped on 14hospital day because of the patient's refusal. The patient increased her exercises including rehabilitation in spite of getting worse in her liver function and nutrition. On 99-hospital day, second hypoglycemic coma attack happened, resulting in early recovery by glucose infusion. Her body weight increased after she accepted continuous intravenous hyperalimentation therapy under resting conditions. The patient was discharged from the hospital at the body weight of 43.0 kg on 275-hospital day. In the present case, a relative hyperactivity, one of the characteristics of AN, and liver dysfunction under the malnutrition may be risk factors to induce hypoglycemic coma in AN.