Rod McClymont, Consultant Paediatrician and Adolescent Physician, Dubbo Base Hospital, NSW, Australia
17 July 2004
The principles illustrated in this case hold true in the adolescent age group. A 19 year old female with a 6 month history of progressive intake restriction and weight loss was referred to me for management with a diagnosis of anorexia nervosa. She had a very low BMI and denied any symptoms suggestive of gastrointestinal or other chronic disease process. Initial examination was as expected except for tachycardia- a very unusual finding. The albumin was a little low and the ESR a little raised- again very unusual findings. She turned out to have Crohn's Disease isolated to the terminal ileum and regained weight steadily when this was treated.
Standing tachycardia, usually with significant postural hypotension, can be a sign of dehydration from fluid restriction in anorexia nervosa. These patients will be normocardic or bradycardic when supine however.
Tachycardia in a low weight patient with or without a true history of anorexia nervosa should always raise suspicions of an underlying inflammatory or infective illness. Likewise, a low albumin level is a very rare, late and worrying finding in anorexia nervosa and should prompt a search for other causes.
Anorexic but not Nervous
17 July 2004
The principles illustrated in this case hold true in the adolescent age group. A 19 year old female with a 6 month history of progressive intake restriction and weight loss was referred to me for management with a diagnosis of anorexia nervosa. She had a very low BMI and denied any symptoms suggestive of gastrointestinal or other chronic disease process. Initial examination was as expected except for tachycardia- a very unusual finding. The albumin was a little low and the ESR a little raised- again very unusual findings. She turned out to have Crohn's Disease isolated to the terminal ileum and regained weight steadily when this was treated.
Standing tachycardia, usually with significant postural hypotension, can be a sign of dehydration from fluid restriction in anorexia nervosa. These patients will be normocardic or bradycardic when supine however.
Tachycardia in a low weight patient with or without a true history of anorexia nervosa should always raise suspicions of an underlying inflammatory or infective illness. Likewise, a low albumin level is a very rare, late and worrying finding in anorexia nervosa and should prompt a search for other causes.
Competing interests
None declared