Endgames Case Report

Weight loss in an adolescent girl

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1327 (Published 06 February 2014) Cite this as: BMJ 2014;348:g1327
  1. Mallika Punukollu, specialist registrar in child and adolescent mental health services (CAMHS)1,
  2. Saman Khan, specialist registrar in CAMHS2,
  3. Dianne Forsyth, consultant in CAMHS psychiatry3
  1. 1Possilpark CAMHS, Glasgow G22 5DE, UK
  2. 2Skye House In-patient Adolescent Unit, Stobhill Hospital, Glasgow, UK
  3. 3South CAMHS, Glasgow, UK
  1. Correspondence to: M Punukollu mpunukollu{at}gmail.com

A 15 year old girl who had been previously fit and well presented to the child and adolescent mental health services (CAMHS) team with weight loss, irregular menstrual periods, excessive exercise, restriction of energy intake during the day, and binging during the evening, followed by vomiting. Her symptoms had been present for a year, since her father had experienced a myocardial infarction. Clinically her symptoms were in keeping with anorexia nervosa, as shown by her completed eating disorder questionnaire.1 Her body mass index (BMI) was 16 and her weight for height was 85% of the median (50th centile) for age and sex. She had a distorted body image, believing her stomach and ankles were too fat, and she had an extreme fear of gaining weight.

She was admitted to an acute medical unit as an emergency after developing severe dehydration with hypotension, tachycardia, dizziness, low energy, and inability to concentrate.

She was found to have hypokalaemia, hypophosphataemia, high bicarbonate levels, and a high amylase concentration. She was given fluid replacement and her electrolyte balance was corrected. CAMHS and the specialist eating disorders team followed her up in the community.

Questions

  • 1 What is the cause of the blood result picture?

  • 2 What are the classic complications of eating disorders in adolescents?

  • 3 What is the most effective evidence based psychiatric treatment for adolescents with anorexia nervosa?

  • 4 What further tests can be helpful in assessment?

  • 5 Can we feed an adolescent under the Mental Health Act?

Answers

1 What is the cause of the blood result picture?

Short answer

This picture is caused by excessive vomiting in patients with an eating disorder who are underweight or normal weight. It can also be seen in patients who have been severely restricting their diet or have stopped eating but have had feeding reinstated, putting them at risk of refeeding syndrome.

Long answer

Hypokalaemia is caused by self …

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