Elevated Transaminases as a Predictor of Coma in Anorexia Nervosa
Elevated Transaminases as a Predictor of Coma in Anorexia Nervosa
Introduction: Liver injury is a frequent complication associated with anorexia nervosa, and steatosis of the liver is thought to be the major underlying pathology. However, acute hepatic failure with transaminase levels over 1000 IU/mL and deep coma are very rare complications and the mechanism of pathogenesis is largely unknown.
Case presentation: A 37-year-old Japanese woman showed features of acute liver failure and hepatic coma which were not associated with hypoglycemia or hyper-ammonemia. Our patient's consciousness was significantly improved with the recovery of liver function and normalization of transaminase levels after administration of nutritional support.
Conclusions: Our case report demonstrates that transaminase levels had an inverse relationship with the consciousness of our patient, although the pathogenesis of coma remains largely unknown. This indicates that transaminase levels can be one of the key predictors of impending coma in patients with anorexia nervosa. Therefore, frequent monitoring of transaminase levels combined with rigorous treatment of the underlying nutritional deficiency and psychiatric disorder are necessary to prevent this severe complication.
Anorexia nervosa (AN) is a difficult-to-treat psychosomatic disease. Mild liver injury is regularly detected as a complication of AN. Although severe acute liver injury has been previously described in a patient with AN, the underlying pathogenetic mechanisms remain largely unclear. Furthermore, only a few cases of AN with deep coma have been reported, mostly due to hypoglycemic coma.
Our case report describes a patient with AN who rapidly developed deep coma associated with acute liver failure, which was rapidly improved by initiation of total parenteral nutrition (TPN) and enteral feedings via a nasogastric (NG) tube.
Abstract and Introduction
Abstract
Introduction: Liver injury is a frequent complication associated with anorexia nervosa, and steatosis of the liver is thought to be the major underlying pathology. However, acute hepatic failure with transaminase levels over 1000 IU/mL and deep coma are very rare complications and the mechanism of pathogenesis is largely unknown.
Case presentation: A 37-year-old Japanese woman showed features of acute liver failure and hepatic coma which were not associated with hypoglycemia or hyper-ammonemia. Our patient's consciousness was significantly improved with the recovery of liver function and normalization of transaminase levels after administration of nutritional support.
Conclusions: Our case report demonstrates that transaminase levels had an inverse relationship with the consciousness of our patient, although the pathogenesis of coma remains largely unknown. This indicates that transaminase levels can be one of the key predictors of impending coma in patients with anorexia nervosa. Therefore, frequent monitoring of transaminase levels combined with rigorous treatment of the underlying nutritional deficiency and psychiatric disorder are necessary to prevent this severe complication.
Introduction
Anorexia nervosa (AN) is a difficult-to-treat psychosomatic disease. Mild liver injury is regularly detected as a complication of AN. Although severe acute liver injury has been previously described in a patient with AN, the underlying pathogenetic mechanisms remain largely unclear. Furthermore, only a few cases of AN with deep coma have been reported, mostly due to hypoglycemic coma.
Our case report describes a patient with AN who rapidly developed deep coma associated with acute liver failure, which was rapidly improved by initiation of total parenteral nutrition (TPN) and enteral feedings via a nasogastric (NG) tube.