Severe Anorexia Nervosa Treated with Total Parenteral Nutrition: Clinical Course and Influence on Clinical Chemical Analyses

ABSTRACT. Severe anorexia nervosa in which psychiatric treatment has failed is a life-threatening condition since the degree of emaciation can be profound. Nine young women with a weight loss of 25-50 % of their habitual weights were given total parenteral nutrition (TPN) over 3-8 weeks through a tunneled central venous silicone catheter. They initially received a mean of 55 kcal/kg body weight/24 hours increasing to 65-70 kcal/kg body weight during the first week. The initial bradycardia and hypotension were normalized and body weight increased with a mean of 2.5 kg/week. All patients showed a general somato-psychic improvement after two weeks of TPN. The electrolyte disturbances seen at the beginning were normalized during the first weeks of treatment and the previously reported life-threatening electrolyte disturbances and dehydration in connection with TPN treatment were not seen. The only adverse effect registered was a rise in liver enzymes in two patients who were given >80 kcal/kg and day. With a reduction of the caloric supply these changes normalized, and TPN could be continued. After 3-8 weeks the oral intake had normalized and TPN was discontinued. – This study confirms that TPN can be used successfully and with minimal risk in severe anorexia nervosa until the patients have normalized their oral intake.     

PHYSIOLOGICAL CORTISOL SUBSTITUTION OF LONG-TERM STEROID-TREATED PATIENTS UNDERGOING MAJOR SURGERY

In 22 patients undergoing elective surgery, adrenal functionwas assessed before and on the day of surgery. Patients receivingcorticosteroid therapy but with a normal cortisol response toa corticotropin stimulation test (group II, n = 8) were notgiven hydrocortisone on the day of operation. Their cortisolconcentration increased in a manner similar to patients (groupI, n = 8) who had never had corticosteroid treatment. The plasmacortisol concentrations in these two groups were less than insubjects (group III, n = 6) with an impaired cortisol responseto corticotropin stimulation, who were given hydrocortisone25 mg at the induction of anaesthesia followed by a continuousinfusion of hydrocortisone 100 mg during the next 24h. Therewere no clinical signs of circulatory insufficiency in any group.The low-dose hydrocortisone therapy regimen is sufficient forsubstitution of adrenal function during surgery and in the earlypostoperative phase. It could lead to mild oversubstitutionin patients with impaired adrenal insufficiency undergoing majorsurgery.