“Fixing a heart”: the game of electrolytes in anorexia nervosa

A 25-year-old woman with chronic anorexia nervosa and depression presented with sudden weakness and fatigue. Psychosocial history was notable for binge-starve cycles over the past year and a decline in overall well-being. Vitals on presentation were notable for hypothermia, hypotension, and bradycardia. Initial exam was significant for emaciation, lethargy, and lower extremity edema. Laboratory work-up revealed markedly elevated LFTs, hypoglycemia, thrombocytopenia and elevated INR and lipase. ECG showed sinus bradycardia with prolonged QTc. Ultrasound revealed normal liver and biliary tree. Serum acetaminophen, alcohol level, and urinary toxicology were unremarkable. Work up for infectious, autoimmune, and genetic causes of hepatitis was negative. Echocardiogram revealed left ventricular hypokinesis and EF 10-15%. Nutritional support was begun slowly, however electrolyte derangements began to manifest on hospital day 2, with hypophosphatemia, hypokalemia, hypocalcemia, and hypomagnesemia. Multiple medical and psychiatric disciplines were consulted, and aggressive electrolyte monitoring and repletion were done. The patient’s overall clinical status improved slowly during her hospital course. Her liver enzymes trended down, and her QTc interval eventually returned toward the normal range. Repeat echocardiogram following treatment revealed improvement of her EF to 40%. Anorexia nervosa is an eating disorder characterized by extremely low body weight, fear of gaining weight or distorted perception of body image, and amenorrhea. Anorexia can lead to life threatening medical complications, and thus constitutes a major challenge to manage. Central to the pathogenesis of the refeeding syndrome is a weakened cardiopulmonary system, electrolytes abnormalities, hepatic dysfunction, liver hypoperfusion and failure. Given the clinical presentation, this patient likely presented on the brink of developing frank refeeding syndrome, with cardiac dysfunction and hypovolemia, leading to hepatic hypoperfusion and ischemic hepatitis. Subsequently, she developed electrolyte disturbances characteristic of refeeding syndrome, which were managed without major complication. Her hospital course is encouraging not only for her recovery, but for the collaboration of the different teams involved in her care, and it highlights the importance of a multidisciplinary approach to caring for patients with the potential dire complications of a complex psychiatric illness

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Not AvailableCoconut products have a great role to play in the fast developing functional food sector. In this pretext, a study was carried out using tender coconut water (TCW), ripened coconut water (RCW) and coconut milk (CM) as ice flake substitute in meat emulsion. Increasing concentrations of each of this substituent, 0%, 25%, 50%, 75% and 100% was used to replace ice flakes in chicken nuggets formulation and the quality parameters were studied. Among the three treatments, the results were nearly identical for TCW and RCW, while CM addition showed most satisfactory results. In nuggets with TCW and RCW, a significant (P<0.05) decrease was observed in moisture and pH, while a significant increase was observed in ash content and standard plate count (SPC). A slight increase in crude protein, fat and shear force was also observed with addition of TCW and RCW. There was no statistical significance in sensory parameters except for flavour in RCW added chicken nuggets. CM added nuggets showed a statistically significant (P<0.05) increase in sensory scores and 100% substitution of ice flakes with CM showed highest sensory scores except for juiciness. In CM incorporated nuggets, moisture content and pH value decreased significantly (P<0.05) where as ash and CP content increased significantly (P<0.05). Moreover higher level of CM addition resulted in higher binding ability of meat emulsion. The microbiological analysis showed a non significant increase. The results showed that among three ice flakes substitutes studied, CM was found more effective in enhancing the quality of chicken nuggets.Not Availabl

An Atypical Case of Eosinophilic Gastroenteritis Presenting as Hypovolemic Shock

Eosinophilic gastroenteritis is an uncommon condition characterized by focal or diffuse infiltration of eosinophils in the gastrointestinal tract in the absence of secondary causes. The pathogenesis of this condition is not well understood and its clinical presentation depends on the segment and layer of the gastrointestinal tract affected. The definition of eosinophilic gastroenteritis may be difficult, as the normal ranges of eosinophil numbers in normal and abnormal gastric and intestinal mucosa are not standardized. We present the case of a 59-year-old male who came to the hospital with hypovolemic shock and lethargy secondary to severe diarrhea. Laboratory analysis was significant for peripheral eosinophilia, and pathology from both the duodenum and colon showed marked eosinophilic infiltration