A case of anorexia nervosa who presented hypoglycemic coma

Hypoglycemia is a common manifestation of anorexia nervosa. Despite the chronic malnutrition seen in anorexia nervosa, symptomatic hypoglycemia has been only rarely described. We report here a man with anorexia nervosa who was in coma with hypoglycemia, consequently suffered from respiratory arrest. He regained consciousness following intensive therapy by artificial respirator. This 30-year-old man had a 15-year history of anorexia nervosa and had been hospitalised several times. After a fifth admission, he attended a religious training center for psychological reasons. However, he continued to restrict his food intake and was losing weight, was complaining of high fever and general fatigue, and was, therefore, brought to the hospital. On admission, his chest X-rays showed a diffuse pneumonia, although arterial blood gas analysis was within the normal range. On the first night, he suddenly became comatose with apnea. Brain CT showed no abnormality and blood pressure was normal. Blood glucose level was 25 mg/dl. Biochemical studies showed no other abnormal findings related to the coma, with suppressed levels of insulin and elevation of growth hormone and cortisol levels, suggesting that the coma was due to hypoglycemia related to severe malnutrition. Immediately after onset of coma and apnea, he was intubated and total parenteral nutrition was begun after which he recovered consciousness on the third day. He finally recovered to the normal state and discharged on the 71st day of admission. A case of anorexia nervosa with hypoglycemic coma with apnea is documented. This suggests that prompt diagnosis and treatment are necessary for anorexia nervosa patients who present in a coma because of the high possibility of death due to hypoglycemic attack as described in this report.