DOCSLIB.ORG

A Situation of Malnutrition with Peculiar Changes in the Immune System

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Situation of Malnutrition with Peculiar Changes in the Immune System European Journal of Clinical Nutrition (2000) 54, Suppl 1, S61±S64 ß 2000 Macmillan Publishers Ltd All rights reserved 0954±3007/00 $15.00 www.nature.com/ejcn Eating disorders: a situation of malnutrition with peculiar changes in the immune system A Marcos* Instituto de NutricioÂn, Facultad de Farmacia, Ciudad Universitaria, Madrid 28040, Spain Eating disorders, such as anorexia nervosa and bulimia nervosa, are signi®cant public health concerns for a great deal of the population, and thus are even considered to be epidemics. These syndromes have a common aim: the pursuit of a desirable and extremely low weight, which is obviously very far from the ideal body weight. Therefore, these patients show abnormal food behavior, leading to a situation of malnutrition. Nutrients play an important role in the development and functionality of the immune system. Thus, the assessment of immunological parameters acquires great interest as a useful tool to evaluate the nutritional status of these patients. In addition, it is very well known that a depleted immune system as a consequence of malnutrition is linked to an increased susceptibility to infections. However, an extensive literature has pointed out that anorexic patients, even though severely malnourished, are relatively free from infectious diseases. As the immune system is altered by distorted food behaviors, such as in case of eating disorders, the awareness of the characteristics of other systems involved in these pathologies, and therefore altered, would be very helpful for the understanding of the mechanisms triggered in these syndromes. In fact, the interactions among the immune system and the remaining systems in eating disorders are beginning to be studied. Finally, the main goal is to limit the evolution of these illnesses through an early diagnosis and appropriate therapy to subsequently get a constant and de®nitive cure for the patients. Descriptors: anorexia nervosa; bulimia nervosa; immune system; nutritional status European Journal of Clinical Nutrition (2000) 54, Suppl 1, S61±S64 Introduction both syndromes are associated with serious morbidity and mortality. In general, the prognosis for severe and refrac- Anorexia nervosa (AN) and bulimia nervosa (BN) are tory BN is less favorable than for uncomplicated AN. psychiatric illnesses that are typi®ed by abnormal eating Serious medical complications are more likely to occur in patterns. These patients respond differently to the macro- those cases with the presence of self-induced vomiting, nutrient content of food (fat, carbohydrate and protein) than which might impair the prognosis of the evolution of the normal subjects do (Drenowski et al, 1988). illness (Comerci, 1990, Garner, 1993). These pathologies AN is a syndrome which mainly includes three features: are frequently associated with depression and anxiety a marked fear of fatness, a disturbed perception of body (DSM-III-R) (American Psychiatric Association, 1987), size (body image), and an obsessive desire to lose increas- thus they have been classi®ed as multifactorial disorders ing amounts of weight (American Psychiatric Association, (Garner, 1993; Pomeroy et al, 1994). 1987). The rest of the symptoms and characteristics are shown in Table 1. Besides, anorexia, per se, usually is not associated with AN; the appetite in AN remains normal or The immune system is increased until late in the course of the illness (Comerci, The complexity of the interactions between nutrition, 1990). immunity and infection is well recognized (Scrimshaw & Similarly to AN, patients with BN pursue thinness. SanGiovanni, 1997). Nutrients are known to play an However, in BN the distinguishing feature is binge important role in the appropriate maintenance of the eating, which is the rapid consumption of a large quantity immune mechanisms involved in the defence of the host of food in a discrete period of time, usually less than 2 h, (Chandra, 1997). invariably followed by purging. This abnormal eating Despite the fact that all the processes that occur in these behaviour could simply be an attempt to satisfy hunger syndromes may affect immune functions, few studies have without gaining weight (Chiodo & Latimer, 1983) and may focused on this ®eld, and the results are controversial represent an attempt to use food to relieve dysphoria and=or (Marcos, 1997). Nutrients are capable of modulating cyto- anxiety (Kaye et al, 1986). Table 1 summarizes the main kines, and hence cytokine participation is essential in features of patients with AN or BN (American Psychiatric triggering certain mechanisms involved in infection pro- Association, 1994). cesses (Grimble, 1994). These disorders usually occur in girls during early to late It is important to stress the fact that infection-induced adolescence. Long-term follow-up studies indicate that malnutrition, the most common form of cytokine-induced malnutrition, results from the actions of proin¯ammatory *Correspondence: A Marcos, Instituto de NutricioÂn, Faculdad de cytokines such as tumor necrosis factor, and interleukins-1 Farmacia, Ciudad Universitaria, Madrid 28040, Spain. and-6. These cytokines are known to be able to initiate an E-mail: [email protected] acute phase reaction, which is quite stereotyped, including Eating disorders and the immune system A Marcos S62 Table 1 DSM-IV diagnostic criteria for anorexia nervosa and bulimia nervosa Anorexia nervosa Bulimia nervosa A. Refusal to maintain body weight over a minimally normal weight for A. Recurrent episodes of binge eating. An episode of binge eating is age and height (e.g. weight loss leading to maintenance of body weight characterised by both of the following: 15% below that expected), or failure to make expected weight gain (1) eating in a discrete period of time (e.g. within any 2-hour period), during period of growth, leading to body weight below 15% of that an amount of food that is de®nitely larger than most people would eat expected. in a similar period of time in similar circumstances; and B. Intense fear of gaining weight or becoming fat, even though under- (2) a sense of lack of control over eating during the episode (e.g. a weight. feeling that one cannot stop eating or control what or how much one C. Disturbance in the way in which one's body weight or shape is is eating). experienced, undue in¯uence of body shape and weight on self- B. Recurrent inappropriate compensatory behaviour to prevent weight evaluation, or denial of the seriousness of current low body weight. gain, such as self-induced vomiting; misuse of laxatives, diuretics, or D. In postmenarchal females, amenorrhea, i.e. the absence of at least three other medications; fasting; or excessive exercise. consecutive menstrual cycles. (A woman is considered to have C. The binge eating and inappropriate compensatory behaviours both amenorrhea if her periods occur only following hormone, e.g. occur, on average, at least twice a week for 3 months. estrogen administration). D. Self evaluation is unduly in¯uenced by body shape and weight. Restricting type: during the episode of anorexia nervosa, the person does E. The disturbance does not occur exclusively during episodes of not regularly engage in binge eating or purging behaviour (i.e. self- anorexia nervosa. induced vomiting or the misuse of laxatives or diuretics). Purging type: the person regularly engage in self-induced vomiting or the Binge eating=purging type: during the episode of anorexia nervosa, the misuse of laxatives or diuretics. person regularly engage in binge eating or purging behaviour (i.e. self- Nonpurging type: the person uses other inappropriate compensatory induced vomiting or the misuse of laxatives or diuretics). behaviours, such as fasting or excessive exercise, but does not regularly engage in self-induced vomiting or the misuse of laxatives or diuretics. leukopenia with relative lymphocytosis and a very depleted CD4=CD8 ratio, an index of nutritional status. This out- come is typical, especially in those patients who haven't been properly diagnosed and treated at the onset of the illness (Marcos et al, 1993a, b, 1997a). In a one-year follow-up study where 15 patients with AN were properly diagnosed and treated from the onset of the illness, a tendency to leukopenia was shown. In addi- tion, a relative lymphocytosis was found, but only at the ®rst stage of the study (at admission to the hospital). Lymphocyte subsets of these patients showed some altera- Figure 1 Interrelationships among cytokines, nutrients and infection. tions compared with controls during the follow-up. Thus, at admission, all the subsets, except CD19 cells, were lower than in the control group. During this year, an improvement fever, loss of appetite, decreased food intake, cellular in CD2, CD3, CD4 and CD8 subsets was shown 2 months hypermetabolism and multiple endocrine and enzyme after admission. It is at this point precisely when patients responses, among other symptoms (Grimble, 1994; Figure had left the hospital and were at home. However, during the 1). However, in the speci®c case of eating disorders, following stages, the levels of the lymphocyte subsets patients do not show exactly this stereotyped reaction, decreased again. Regarding natural killer (NF) cells, they especially that related to fever. In our research group we remained at very low levels during the one-year follow-up. consider the presence of fever a symptom of improvement, even during hospitalization, and it is commonly a motive to congratulate the patient. These cytokines are capable of activating the hypotha- lamic ± pituitary ± adrenal axis (HPAA) and to have a direct stimulatory effect on adrenal corticosterone secretion in vitro. In turn, glucocorticoids alter the production of these cytokines, as a feedback mechanism (Beisel, 1995). Although all these cytokines are impaired in protein- energy malnutrition, they do not seem to be depleted in eating disorders. On the contrary, some authors have reported a spontaneous and elevated production, contribut- ing to weight loss, cachexia and osteoporosis in AN patients (GonzaÂlez-HernaÂndez et al, 1995).
Load more

Recommended publications
  • THE IMPORTANCE of NUTRITION AS the BEST MEDICINE for EATING DISORDERS Carolyn Coker Ross, MD, MPH
    DIET AND NUTRITION THE IMPORTANCE OF NUTRITION AS THE BEST MEDICINE FOR EATING DISORDERS Carolyn Coker Ross, MD, MPH ver seven million girls and women groups. Current research demonstrates to 24, and the suicide rate was 75 times and one million boys and men that eating disorder symptoms may be as higher. will suffer from an eating disorder common or more common among certain Medical consequences of eating disor- in their lifetime. Up to 3.7% of ethnic groups (Asians, blacks, and Hispan- ders include arrested sexual maturity and O 6 females will be diagnosed with anorexia ics) when compared with whites. There growth failure in prepubertal patients. nervosa and an estimated 4.2% will have was no difference found in dieting and Many with eating disorders may look and bulimia nervosa.1 The majority of adoles- restraint scores between Asian, Latino, feel deceptively well and may have normal cent patients seen in referral centers fit and white adolescent girls and boys7 and electrograms but are still at high risk for into a third category, “eating disorder not no difference in binging or BED in obese cardiac arrhythmias and sudden death. otherwise specified” or EDNOS and do patients who sought to lose weight with Prolonged amenorrhea is associated with not fit strict criteria for either anorexia or bariatric surgery.8 These changes may be an increased risk of osteopenia and rate of bulimia.2 Nineteen percent of college- related to an extension of cultural ideals in fractures. Neuroimaging studies with com- aged females are bulimic; many go undi- these ethnic populations of what is attrac- puterized tomography (CT) have demon- agnosed until much later.
    [Show full text]
  • Common Signs and Symptoms of Eating Disorders (Anorexia/Bulimia)
    Common Signs and Symptoms of Eating Disorders (Anorexia/Bulimia) 1. Dramatic weight loss in a relatively short period of time. 2. Wearing big or baggy clothes or dressing in layers to hide body and/or weight loss. 3. Obsession with calories and fat content of foods. 4. Obsession with continuous exercise. 5. Frequent trips to the bathroom immediately following meals (sometimes accompanied with water running in the bathroom for a long period of time to hide the sound of vomiting). 6. Visible food restriction and self-starvation. 7. Visible bingeing and/or purging. 8. Use or hiding use of diet pills, laxatives, ipecac syrup (can cause immediate death!) or enemas. 9. Isolation. Fear of eating around and with others. 10. Hiding food in strange places (closets, cabinets, suitcases, under the bed) to avoid eating (Anorexia) or to eat at a later time (Bulimia). 11. Flushing uneaten food down the toilet (can cause sewage problems). 12. Vague or secretive eating patterns. 13. Keeping a "food diary" or lists that consists of food and/or behaviors (ie., purging, restricting, calories consumed, exercise, etc.) 14. Pre-occupation or obsession with food, weight (even if “average” weight or thin), and/or cooking. 15. Visiting websites that promote unhealthy ways to lose weight. 16. Reading books about weight loss and eating disorders. 17. Unusual food rituals: shifting the food around on the plate to look eaten; cutting food into tiny pieces; making sure the fork avoids contact with the lips (using teeth to scrap food off the fork or spoon); chewing food and spitting it out, but not swallowing; dropping food into napkin on lap to later throw away.
    [Show full text]
  • Hypokalaemia in a Woman with Eating Disorder
    Grand Rounds Vol 11 pages 53–55 Specialities: Acute Medicine; Nephrology; Psychiatry Article Type: Case Report DOI: 10.1102/1470-5206.2011.0013 ß 2011 e-MED Ltd Hypokalaemia in a woman with eating disorder Zachary Z. Brenera, Boris Medvedovskya, James F. Winchestera and Michael Bergmanb aDivision of Nephrology, Department of Medicine, Beth Israel Medical Center, Albert Einstein School of Medicine of Yeshiva University, New York, USA; bDepartment of Medicine, Campus Golda, Rabin Medical Center, Petah-Tikva, Tel-Aviv University, Israel Corresponding address: Dr Zachary Z. Brener, 350 E. 17th St., Division of Nephrology, Beth Israel Medical Center, New York, NY 10003, USA. Email: [email protected] Date accepted for publication 13 April 2011 Abstract Chronic hypokalaemia often remains a diagnostic challenge, especially in young women without hypertension. A concealed diuretic abuse should be suspected, especially in young women with eating disorders. This case describes a woman with chronic hypokalaemia in whom a thorough medical history and proper laboratory tests were essential to early and accurate diagnosis. Keywords Hypokalaemia; eating disorders; diuretics. Introduction Chronic hypokalaemia often remains a diagnostic challenge, especially in young women without hypertension. After the exclusion of the most obvious causes, a concealed diuretic abuse associated with or without surreptitious vomiting and laxative abuse should be suspected, especially in young women concerned with their body image. A conclusive diagnosis may be difficult as such patients often vigorously deny diuretic intake[1]. Also, only a minority of patients with eating disorders (approximately 6%) abuse diuretics[2–4]. This case describes a woman with chronic hypokalaemia in whom a thorough medical history and proper laboratory tests were essential to an early and accurate diagnosis.
    [Show full text]
  • Section 15: Treatment of Eating Disorders
    Formulary and Prescribing Guidelines SECTION 15: TREATMENT OF EATING DISORDERS Section 15. Treatment of eating disorders 15.1 Introduction Please review the Trust document “Guidelines for the assessment and treatment of eating disorders” in the CAMHS Operational Policy. When screening for eating disorders one or two simple questions should be considered for use with specific target groups 1. Do you think you have an eating problem? 2. Do you worry excessively about your weight?’ Early detection may be helped by five screening questions using The SCOFF questionnaire. A score of two or more positive answers should raise clinical suspicion and lead to an in depth diagnostic evaluation. 1. Do you ever make yourself Sick because you feel uncomfortably full? 2. Do you worry you have lost Control over how much you eat? 3. Have you recently lost more than One stone in a three month period? 4. Do you believe yourself to be Fat when others say you are too thin? 5. Would you say that Food dominates your life? It is important to take into account that clients with eating disorders can develop Acute Kidney Injury through a variety of mechanisms associated with each condition. Clinicians should be vigilant in the monitoring of physical health especially serum creatinine and levels of hydration.3 15.2 Anorexia nervosa The following would represent a reasonable initial screen for Anorexia Nervosa in primary care if there are no other indications or diagnostic concerns: Full Blood Count, ESR, Urea and Electrolytes, Creatinine, Liver Function Tests, Random Blood Glucose, Urinalysis, ECG (should be considered in all cases and essential if symptoms/signs of compromised cardiac function, bradycardia, electrolyte abnormality and/or BMI less than 15 kg/m2 or equivalent on centile chart).
    [Show full text]
  • Anorexia/Cachexia Heart Failure Symptom Management Guideline for Adults, Age 19 and Older in British Columbia
    Anorexia/Cachexia Heart Failure Symptom Management Guideline For adults, age 19 and older in British Columbia What is anorexia? Anorexia is a syndrome characterized by some or all of the following symptoms: loss of appetite, nausea, early satiety, weakness, fatigue, food aversion, and significant physical and/or psychological symptoms. Causes of anorexia are multifactorial and include fatigue, dyspnea, medication side-effects, nausea, depression, anxiety and sodium restricted diets, which may all be found in patients with heart failure. What is cachexia? Cachexia is a syndrome characterized by severe body weight, fat and muscle loss and increased protein catabolism due to underlying disease. The prevalence of cachexia is 16–42% in the heart failure population and is associated with a 50%, 18 month mortality risk independent of variables such as ejection fraction, age and functional ability. How is cachexia diagnosed? Chronic condition with >5% weight loss in <12 months; or body mass index (BMI) <20kg/m2; and 3 out of 5 additional criteria: 1) Fatigue, 2) Decreased muscle strength, 3) Anorexia, 4) Low muscle mass, 5) Abnormal biochemistry *Blood testing to diagnose cachexia in advanced stages of disease is not advocated. Reminder: Malnutrition also affects prognosis in patients with heart failure and is often found in early transitions of the disease. However this symptom management guideline will focus on the assessment and treatment of anorexia and cachexia. Approach to Managing Anorexia/Cachexia Assessment History: When did weight loss begin? How much weight was lost? Obtain baseline (dry) weight. How is [the patients] appetite? What do they eat or drink on a typical day? How has weight loss affected mood? Ask about: nausea, early satiety, dyspnea, poor oral hygiene, dysphagia, malabsorption, bowel habits.
    [Show full text]
  • Dsm-5 Diagnostic Criteria for Eating Disorders Anorexia Nervosa
    DSM-5 DIAGNOSTIC CRITERIA FOR EATING DISORDERS ANOREXIA NERVOSA DIAGNOSTIC CRITERIA To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met: 1. Restriction of energy intaKe relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. 2. Intense fear of gaining weight or becoming fat, even though underweight. 3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia. BULIMIA NERVOSA DIAGNOSTIC CRITERIA According to the DSM-5, the official diagnostic criteria for bulimia nervosa are: • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: o Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. o A sense of lacK of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
    [Show full text]
  • Cancer Cachexia and Fatigue
    CME Palliative care Cancer cachexia and mechanisms (Fig 1). The cachectic Other cachectic factors patient is analogous to an accelerating Cachexia can occur in the absence of car running out of petrol. The anorexia anorexia, suggesting that catabolic fatigue component of cancer cachexia reduces mediators produced by tumour or host fuel supply (by ca 300–500 kcal/day) cells are involved in the cancer cachexia whilst accelerated metabolic cycling Grant D Stewart BSc(Hons) MBChB MRCS(Ed), process.9 Experimental cachexia models drives hypermetabolism (by ca Surgical Research Fellow suggest pro-inflammatory cytokines, 100–200 kcal/day). There are also the Richard JE Skipworth BSc(Hons) MBChB such as tumour necrosis factor- , inter- direct catabolic effects of muscle proteol- α MRCS(Ed), Surgical Research Fellow leukin (IL)-6, IL-1 and interferon- , can ysis and lipolysis. These changes underlie γ Kenneth CH Fearon MBChB(Hons) MD all play a role. Activation of the neuro- a key paradox of cachexia: whilst meta- FRCS(Glas) FRCS(Ed) FRCS(Eng), Professor of endocrine stress response is also thought bolic rate may be increased, overall (or Surgical Oncology to be important. Potential mediators total) energy expenditure is decreased Department of Clinical and Surgical Sciences include increased adrenergic activity, ele- due to a fall in physical activity.7 (Surgery), University of Edinburgh, Royal vated cortisol, low insulin and increased Infirmary, Edinburgh activity of the renin-angiotensin system.1 Anorexia With regard to tumour-specific Clin Med 2006;6:140–3 The anorexia component of cancer cachectic factors, proteolysis-inducing cachexia has both a neurohumoral mech- factor (PIF) is produced by tumours and anism due to disturbance of the central excreted in the urine of patients with Background physiological mechanisms controlling cancer cachexia.
    [Show full text]
  • Cancer Anorexia Cachexia Syndrome (CACS)
    Cancer Anorexia Cachexia Syndrome (CACS) Amanda Werner, RN, BSN Supportive Care and Vitality Clinics Moffitt Cancer Center Objectives Define CACS Identify contributing factors in CACS Describe the effects of CACS on patient outcomes 58 year old Male Lung Cancer No appetite Significant weight loss: muscle and fat Decreased physical ability and function Family forcing food Patient socially withdrawn Cancer Anorexia Cachexia Syndrome (CACS) Multifactoral syndrome Negative protein and energy balance Ongoing loss of skeletal muscle mass (with/without loss of fat mass) Leads to progressive functional impairment Underlying Mechanisms Symptoms of CACS Poor appetite Involuntary weight loss Increased fatigue Loss of physical strength Cachexia is NOT… Starvation Fully reversed by conventional nutritional support or artificial nutrition Intentional Negative Outcomes Treatment ◦ Poor tolerance to treatment options ◦ Not eligible for treatment due to performance status Physical ◦ Decreased function and ability to complete ADLs Psychosocial ◦ Decreased quality of life ◦ Altered body image ◦ Source of patient/family emotional distress and conflict PATIENTS & CAREGIVERS NEED SUPPORT TO COPE WITH THE DISTRESS OF CACHEXIA 10 Prevalence Varies by tumor type Under recognized ◦ ½ of cancer patients have cachexia ◦ Approx. 30% die from cachexia Under treated ◦ Condition could be present in an obese patient CACS Nutritional Impact Primary Cachexia CACS direct impact on nutrition Secondary Cachexia Impact of cancer & treatment Tertiary
    [Show full text]
  • Health Consequences of Eating Disorders
    Health Consequences of Eating Disorders Eating disorders are serious, potentially life-threatening conditions that affect a person’s emotional and physical health. Eating disorders are not just a “fad” or a “phase.” People do not just “catch” an eating disorder for a period of time. They are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships. People struggling with an eating disorder need to seek professional help. The earlier a person with an eating disorder seeks treatment, the greater the likelihood of physical and emotional recovery. Health Consequences of Anorexia Nervosa In anorexia nervosa’s cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences: Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as the heart rate and blood pressure levels sink lower and lower. Reduction of bone density (osteoporosis), which results in dry, brittle bones. Muscle loss and weakness. Severe dehydration, which can result in kidney failure. Fainting, fatigue, and overall weakness. Dry hair and skin; hair loss is common. Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm. Health Consequences of Bulimia Nervosa The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.
    [Show full text]
  • Pseudo Bartter Syndrome from Surreptitious Purging Behaviour In
    al Dis ion ord rit e t rs u N & f T o h Gentile, J Nutr Disorders Ther 2012, 2:1 l e a r n a r DOI: 10.4172/2161-0509.1000107 p u y o Journal of Nutritional Disorders & Therapy J ISSN: 2161-0509 Case Report Open Access Pseudo Bartter Syndrome from Surreptitious Purging Behaviour in Anorexia Nervosa Maria Gabriella Gentile* Eating Disorder Unit, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20126 Milan, Italy Abstract Pseudo Bartter syndrome is a rare disorder characterized by metabolic alkalosis, hypokalaemia, hyperaldosteronism, hyperreninism, normal blood pressure and hyperplasia of the juxtaglomerular apparatus. The most dangerous complication of Pseudo Bartter syndrome is hypokalemia. Hypokalemia caused by vomiting, diarrhea, prolonged fasting, abuse of potassium-depleting drugs, may be present in patients with binge /purging form of anorexia or bulimia nervosa. We report a case of a 19-year-old girl with anorexia nervosa (BMI 16.15 kg/m2) and severe prolonged hypokalemia (1.9 mEq/l), metabolic alkalosis and severe protracted secondary hyperaldosteronism (i.e. Pseudo Bartter’s syndrome) from surreptitious purging behaviour (vomit and laxative abuse). An intensive multidisciplinary day-hospital treatment including long-term potassium supplementation, a potassium- sparing diuretic was necessary to resolve the case and to allow the young girl to admit her previous purging behaviour and after three months to get at a normal kalemia without any potassium supplementation and BMI at a normal value (20 kg/m2). Given the dangers to the heart electrical and mechanical functions set by severe potassium deficiency, it is mandatory to find out the true cause so that a proper treatment can be started.
    [Show full text]
  • Treating Cachexia-Anorexia in Lung Cancer Patients: What Do Patients Want?
    TREATING CACHEXIA-ANOREXIA IN LUNG CANCER PATIENTS: WHAT DO PATIENTS WANT? A white paper by LUNGevity Foundation All copyrights reserved. Please acknowledge this publication if you use any information within it. ACKNOWLEDGMENTS LUNGevity is deeply indebted to the lung cancer patient/survivor community for taking the time to share their perspectives and make this study possible. AUTHORS LUNGevity Andrea Ferris Susan Mantel Margery Jacobson Upal Basu Roy EdgeResearch Lisa Dropkin Mariel Molina 2 ABOUT LUNGevity LUNGevity, one of the nation's largest lung cancer non-profits, is dedicated to changing outcomes for people with lung cancer through research, education, and support. We focus on research because the link between research spending and improved survival is clear. Survival rates have dramatically improved for colorectal, breast, and prostate cancers over the last several decades in step with the exponential growth in their research spending. Our goal is to accelerate progress for lung cancer in the same way in order to dramatically improve on the current 18% five-year survival rate. LUNGevity research investments focus on early detection because survival rates rise when lung cancer is detected while still localized. We also focus on more effective treatment approaches—getting the right treatment to the right patient at the right time to help people with lung cancer live longer and better. LUNGevity also provides a community of empowerment, support, and hope for everyone affected by lung cancer through our extensive educational resources, online peer-to-peer support, and in-person survivorship programs, as well as through more than 70 grassroots awareness and fundraising events held from coast to coast each year.
    [Show full text]
  • The Medical Issues of Patients with Anorexia and Bulimia
    MEDICAL FOOD FOR THOUGHT: THE MEDICAL ISSUES OF PATIENTS WITH ANOREXIA AND BULIMIA Philip S. Mehler, MD, FACP, FAED, CEDS Executive Medical Director & Chief Medical Officer, Eating Recovery Center Founder, ACUTE @ Denver Health Glassman Professor of Medicine, University of Colorado LEARNING OBJECTIVES: • Identify medical problems related to bulimia nervosa, and how to manage them • Identify medical problems related to anorexia nervosa, and how to manage them • Recognize when a patient needs a higher level of care for ongoing management of medical problems MEDICAL COMPLICATIONS • In anorexia a direct result of starvation and weight loss • In bulimia directly correlated with the mode and frequency of purging behaviors • Litany of medical problems associated with these eating disorders • Most are reversible and treatable – good news, if identified early in the illness • A few are associated with permanent harm MEDICAL COMPLICATIONS OF ANOREXIA NERVOSA Cardiovascular Endocrine and Metabolic Bradycardia and hypotension Amenorrhea Mitral valve prolapse Unintended pregnancy & miscarriages Sudden death - arrhythmia Osteoporosis Refeeding syndrome Thyroid Abnormalities Echo changes Hypercortisolemia Pericardial effusions Hypoglycemia Dermatologic Neurogenic diabetes insipidus Dry skin Hypophosphatemia Alopecia Hematologic Lanugo hair Pancytopenia Starvation-associated pruritis Decreased sedimentation rate Acrocyanosis Neurologic Cerebral atrophy Gastrointestinal Opthalmic Constipation Lagopthalmos Refeeding pancreatitis Auditory Acute gastric
    [Show full text]