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Sounds unrealistic: an adolescent girl with anorexia nervosa consumes 19 L of fluid in a few hours: what happens to the physiology?

Abstract

BACKGROUND

Adolescents with eating disorders (EDs) may present not only with abnormal eating behaviors but also with abnormal drinking behaviors varying widely. These behaviors include water loading to cheat on weight measurements, to feel full and suppress appetite and/or to induce vomiting; as well as restricting fluid intake in addition to food.

METHOD

We present a 16-year-old female adolescent with anorexia nervosa restrictive type and major depressive disorder who was hospitalized due to acute food refusal and developed generalized seizures due to dilutional hyponatremia in consequence of consuming excessive amount of water. Psychiatric diagnoses were made according to 'The Diagnostic and Statistical Manual of Mental Disorders' (5th ed.; DSM-5) criteria.

RESULTS

After starting nutritional rehabilitation with a low calorie meal plan to avoid refeeding syndrome, a weight gain of 2 kg was noted in the second day of hospitalization. At the bedside visit, she was observed in a disoriented manner and consecutively in seconds, lost consciousness with a generalized tonic-clonic seizure lasting 2 min. Her serum sodium level was measured as 116 mEq/L, which was normal at the time of admission. It was later learned that she secretly ingested 19 L of water in a short amount of time. She regained consciousness and no further seizures were observed after intravenous sodium deficit correction and fluid restriction therapy. Her serum sodium level was normalized (137 mEq/L) within 12 h.

CONCLUSION

A thorough clinical assessment of hydration and drinking behaviors as well as eating behaviors is essential for patients with EDs to avoid serious medical complications with high mortality and morbidity during follow-up. It is interesting that this amount of fluid consumption in such a short period of time did not present to the clinic with vomiting, gastric dilatation or bowel irrigation symptoms in a case with acute food refusal and restriction for a year, instead absorbed very quickly causing acute and severe symptomatic hyponatremia with generalized seizures.

Authors+Show Affiliations

Department of Pediatrics, Ankara Child Health and Diseases Hematology and Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey.Department of Child and Adolescent Psychiatry, Hacettepe University School of Medicine, Ankara, Turkey.Department of Pediatrics, Division of Adolescent Medicine, Hacettepe University School of Medicine, Ankara, Turkey.Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey.Department of Pediatrics, Başkent University School of Medicine, Ankara, Turkey.Department of Pediatrics, Division of Adolescent Medicine, Hacettepe University Ihsan Dogramaci Children's Hospital, Hacettepe University School of Medicine, Ankara, Turkey. nuraykanbur@hotmail.com.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31522380

Citation

Oden Akman, Alkim, et al. "Sounds Unrealistic: an Adolescent Girl With Anorexia Nervosa Consumes 19 L of Fluid in a Few Hours: what Happens to the Physiology?" Eating and Weight Disorders : EWD, 2019.
Oden Akman A, Cak HT, Pehlivantürk-Kızılkan M, et al. Sounds unrealistic: an adolescent girl with anorexia nervosa consumes 19 L of fluid in a few hours: what happens to the physiology? Eat Weight Disord. 2019.
Oden Akman, A., Cak, H. T., Pehlivantürk-Kızılkan, M., Balik, Z., Akbulut, O., & Kanbur, N. (2019). Sounds unrealistic: an adolescent girl with anorexia nervosa consumes 19 L of fluid in a few hours: what happens to the physiology? Eating and Weight Disorders : EWD, doi:10.1007/s40519-019-00777-7.
Oden Akman A, et al. Sounds Unrealistic: an Adolescent Girl With Anorexia Nervosa Consumes 19 L of Fluid in a Few Hours: what Happens to the Physiology. Eat Weight Disord. 2019 Sep 14; PubMed PMID: 31522380.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sounds unrealistic: an adolescent girl with anorexia nervosa consumes 19 L of fluid in a few hours: what happens to the physiology? AU - Oden Akman,Alkim, AU - Cak,H Tuna, AU - Pehlivantürk-Kızılkan,Melis, AU - Balik,Zeynep, AU - Akbulut,Ozlem, AU - Kanbur,Nuray, Y1 - 2019/09/14/ PY - 2019/06/28/received PY - 2019/09/04/accepted PY - 2019/9/16/entrez PY - 2019/9/16/pubmed PY - 2019/9/16/medline KW - Adolescent KW - Anorexia nervosa KW - Hyponatremia KW - Seizure KW - Water intoxication JF - Eating and weight disorders : EWD JO - Eat Weight Disord N2 - BACKGROUND: Adolescents with eating disorders (EDs) may present not only with abnormal eating behaviors but also with abnormal drinking behaviors varying widely. These behaviors include water loading to cheat on weight measurements, to feel full and suppress appetite and/or to induce vomiting; as well as restricting fluid intake in addition to food. METHOD: We present a 16-year-old female adolescent with anorexia nervosa restrictive type and major depressive disorder who was hospitalized due to acute food refusal and developed generalized seizures due to dilutional hyponatremia in consequence of consuming excessive amount of water. Psychiatric diagnoses were made according to 'The Diagnostic and Statistical Manual of Mental Disorders' (5th ed.; DSM-5) criteria. RESULTS: After starting nutritional rehabilitation with a low calorie meal plan to avoid refeeding syndrome, a weight gain of 2 kg was noted in the second day of hospitalization. At the bedside visit, she was observed in a disoriented manner and consecutively in seconds, lost consciousness with a generalized tonic-clonic seizure lasting 2 min. Her serum sodium level was measured as 116 mEq/L, which was normal at the time of admission. It was later learned that she secretly ingested 19 L of water in a short amount of time. She regained consciousness and no further seizures were observed after intravenous sodium deficit correction and fluid restriction therapy. Her serum sodium level was normalized (137 mEq/L) within 12 h. CONCLUSION: A thorough clinical assessment of hydration and drinking behaviors as well as eating behaviors is essential for patients with EDs to avoid serious medical complications with high mortality and morbidity during follow-up. It is interesting that this amount of fluid consumption in such a short period of time did not present to the clinic with vomiting, gastric dilatation or bowel irrigation symptoms in a case with acute food refusal and restriction for a year, instead absorbed very quickly causing acute and severe symptomatic hyponatremia with generalized seizures. SN - 1590-1262 UR - https://www.unboundmedicine.com/medline/citation/31522380/Sounds_unrealistic:_an_adolescent_girl_with_anorexia_nervosa_consumes_19_L_of_fluid_in_a_few_hours:_what_happens_to_the_physiology L2 - https://dx.doi.org/10.1007/s40519-019-00777-7 DB - PRIME DP - Unbound Medicine ER -