Anorexia Nervosa

A Multi-Disciplinary Approach to Managing End-Stage Renal Disease in Anorexia Nervosa: A Case Report

Clinical Medicine Insights: Case Reports
By Vishnupriya "Priya" Khatri, MD Maryrose Bauschka, MD, CEDS Meghan Foley, RD, CEDS Cheryl Lundberg, PsyD, CEDS Philip S. Mehler, MD, FACP, FAED, CEDS

Research Asset

Abstract

Background: Renal dysfunction and electrolyte abnormalities are common complications of anorexia nervosa (AN), particularly in the binge-eating/purging type (AN-BP). Hypokalemic, or kaliopenic, nephropathy is an established clinical entity and a leading cause of end-stage renal disease (ESRD) in AN. Here, we present a case which demonstrates the difficulties of managing refeeding and nutrition in a psychiatrically and medically complex patient with severe AN-BP and ESRD most likely secondary to hypokalemic nephropathy.

Case report: A 54-year-old female with AN-BP that has resulted in chronic hypokalemia, with newly diagnosed ESRD on hemodialysis, presented to an eating disorder medical stabilization unit for weight restoration and treatment of the medical complications associated with her severe malnutrition and ESRD. She was admitted with a body mass index (BMI) of 15 kg/m2, serum potassium of 2.8 mmol/L and serum creatinine of 6.91 mg/dL. She had failed to gain weight in the outpatient setting while on hemodialysis. She initially denied having an eating disorder, but ultimately a history of excessive laxative abuse for many years, without primary physician follow up, was revealed. While she did not undergo a renal biopsy to confirm the etiology of her ESRD, given her history of long-standing hypokalemia and lack of other risk factors, her ESRD was presumed to be secondary to hypokalemic nephropathy. She required significant oversight from a multidisciplinary eating disorder treatment team to restore weight while also managing her ESRD.

Conclusion: This case report highlights the complexity of managing ESRD in patients with AN who require weight restoration. A multidisciplinary team was vital to ensure this patient's adherence to treatment. With this case, we hope to raise awareness of the deleterious effect on the kidneys from prolonged hypokalemia, the elevated risk of poor renal outcomes in patients with AN-BP, and the danger of easy accessibility to over-the-counter stimulant laxatives.

Written by

Vishnupriya "Priya" Khatri, MD

Dr. Priya Khatri joined the ACUTE Center for Eating Disorders & Severe Malnutrition in 2019 as a Hospitalist. Dr. Priya Khatri joined the ACUTE team in 2019. She finds working with a dedicated…
Written by

Meghan Foley, RD, CEDS

Meghan Foley, RD, CEDS became a registered dietitian in 2011, after completing her undergraduate degree in Nutrition and Dietetics from Penn State University followed by her dietetic internship at the…
Written by

Cheryl Lundberg, PsyD, CEDS

Dr. Cheryl Kornfeld works as a licensed clinical psychologist at the ACUTE Center for Eating Disorders at Denver Health, the country’s center of excellence for those with the most extreme forms of…
Written by

Philip S. Mehler, MD, FACP, FAED, CEDS

Dr. Philip S. Mehler began his career at Denver Health more than 35 years ago and was formerly its Chief of Internal Medicine and then Denver Health’s Chief Medical Officer (CMO) until he was promoted…

ACUTE Earns Prestigious Center of Excellence Designation from Anthem
In 2018, the ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health was honored by Anthem Health as a Center of Excellence for Medical Treatment of Severe and Extreme Eating Disorders. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. It comes after a rigorous review process.

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