SHM Converge Scientific Abstract ePoster Gallery-Severe Starvation Hepatitis in a 36 Year Old Male With Anorexia Nervosa

Pdf Summary

A 36-year-old man with anorexia nervosa presented with progressive weakness over two months after three years of severe dietary restriction, daily milk of magnesia use, and a 120-pound weight loss. He was too weak to perform simple tasks such as tying his shoes. On exam, he was bradycardic and hypotensive but otherwise without focal findings.<br /><br />Initial labs showed pancytopenia and marked hepatocellular injury: WBC 2.3 K/uL, hemoglobin 11.4 g/dL, platelets 104 K/uL, ALT 1009 U/L, AST 551 U/L, with normal bilirubin, alkaline phosphatase, INR, and glucose. RUQ Doppler ultrasound was normal. He received IV fluids without improvement in blood pressure and was evaluated by nutrition with recommendations to increase oral intake.<br /><br />A broad liver workup was negative, including ceruloplasmin, autoimmune markers, viral hepatitis testing, EBV, CMV, HSV, HIV, and repeat Doppler imaging. By hospital day 5, his liver enzymes improved substantially (ALT 559 U/L, AST 150 U/L), supporting a diagnosis of starvation hepatitis rather than primary hepatic disease.<br /><br />The case highlights serious medical complications of anorexia nervosa, including hypotension, bradycardia, pancytopenia, hypoglycemia, and starvation hepatitis. Starvation hepatitis typically causes transaminase elevation with ALT greater than AST and relatively normal bilirubin and alkaline phosphatase. Severe cases can produce AST/ALT in the thousands, especially at very low BMI. The condition usually improves with nutritional rehabilitation.

Asset Subtitle

Andrew L. Wu

Meta Tag

Author List Andrew L. Wu, Ziad Sad Aldeen

Category Clinical Vignettes

Concept Anorexia Nervosa

Concept Starvation Hepatitis

Concept Nutritional Rehabilitation

Concept Hypotension

Concept Bradycardia

Distinguished Non-Finalist

Presenter Organization University of Wisconsin

Presenting Author Andrew L. Wu

Track Adult

Keywords

anorexia nervosa

starvation hepatitis

transaminase elevation

pancytopenia

bradycardia

hypotension

severe dietary restriction

nutritional rehabilitation

liver injury

weight loss

Anorexia Nervosa

Starvation Hepatitis

Nutritional Rehabilitation

Hypotension

Bradycardia