Has anorexia nervosa. Hepatitis panel negative. Had edema in the lower extremities. What could be done?

Posted on Tue, 4 Jun 2013 in Mental Health
Question: My daughter has anorexia nervosa. Here are
4/30/12 8/9/12 3/29/13 5/10/13
SGOT 44 38 59 88
SGPT 86 60 82 89 Her hepatitis panel is negative. After April of last year Prozac was discontinued as a possible cause of the elevated levels. In August of last year the levels had decreased. Unfortunately my daughter started running at first at a moderate level initially, until last week reaching a threshold of 3.5 hours running. We have stopped her from running and we are in the process of having my daughter transferred to an inpatient eating disorder center. She has had progressively increasing edema of the lower extremities (pitting edema). At first we were wondering if it was circulatory, but heart function was ruled normal by echocardiogram. Her pulses and venous return are normal. Pt. Female 5.0 ft, 84lbs.
Answered by Dr. Seikhoo Bishnoi 6 hours later
Welcome to Health Care Magic

Anorexia Nervosa causes severe malnutrition and multi-organ dysfunction. It is a common disorder in youngsters and more common in girl. Body image distortion is seen in Anorexia Nervosa which results in avoiding meals and compulsive exercises and even purging also. Failure to maintain normal weight is also a common finding. Many psychiatrists advise the patients about inpatient treatment. In indoor treatment nutrition is ensured as well as proper medicines like SSRIs can be given which controls co-morbid depression also.

She was started on Fluoxetine and this drug belongs to SSRI group. It is a safe group and it is metabolized through liver and it may cause elevation in liver enzymes, but that is not so serious. Even in milder form of liver diseases the drug can be given. As per my opinion her liver enzymes raised most likely due to her problem of anorexia. Due to chronic anorexia and poor nutrition multi-organ dysfunction is seen and elevation of liver enzymes is observed. It is a common finding in anorexia patients.

She has developed edema on lower limbs and that may be sign of severe protein malnutrition which can further deteriorate the course. She is just 84lbs and she need inpatient treatment. Please take her to a good psychiatrist and consult about treatment options.
As per my opinion fluoxetine can be given to her.
Her adequate nutrition status should be maintained.
Psychotherapy in form of individual psychotherapy is useful psychological treatment for such patients. Her unresolved conflicts should be resolved.

Hope it clears your doubt, if you have more questions you can ask again.

Dr. Seikhoo Bishnoi, MD
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Seikhoo Bishnoi 7 hours later
If proper nutrition is restored how long can we expect before edema begins to resolve. She has started to increase nutrition and has discontinued all exercise. Thank you for your help, concerned Dad.
Answered by Dr. Seikhoo Bishnoi 1 hour later
Hello again

If proper nutrition is given then edema will resolve in a month only. Diets in excess of 200-300 calories more than expected for that age are sufficient to restore nutritional balance. Psychoanalytic issues still persist in anorexia persist so long term management is needed. Fortunately teen age onset anorexia responds to treatment and in a lot of individuals even without medicines it improves by own.

Provide her proper support and loving care.

Thanks, if you have more questions you can ask again.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Seikhoo Bishnoi 57 minutes later
My daughter spent 7 weeks @ an inpatient then residential Eating Disorder facility two years ago. She returned home well-nourished and much improved but gradually relapsed to her current state. Her current psychiatrist, (age 74, graduate of Baylor Medical School),who has been seeing our daughter since April 1st, does not believe Eating Disorder facilities address the underlying problems. He advises strongly against taking her to any such facility. He also recommended that we stop taking our daughter to see her dietition (a certified E.D. specialist) immediately, claiming that food is not the issue and our daughter knows what to eat. He does not seem to advocate the "team approach." Do you have any experience or thoughts regarding Eating Disorder Centers?
Answered by Dr. Seikhoo Bishnoi 42 minutes later
Hello again

He is absolutely right in the point that she knows what to eat. The main issue is in her mind. Body image distortion occurs in anorexia. Main factors that contribute to development of anorexia are teen age, female sex, cultural factors etc.
Cultural factors are important because in recent times most of societies prefer weight in lower range. In patients of anorexia there occur fixations during developmental states they fail to recognize their low weight and continue to avoid foods and start compulsive exercises.

As I have already mentioned, psychological treatment will be best for her situation. Proper cognitive therapy to correct her faulty cognitive distortions regarding her body and her food habits can easily help her in maintaining normal weight.

In a specific eating disorder facility she will improve but to maintain her proper weight psychological treatment is best. Medicines help in sustaining the remission. If possible admit for few days under Psychiatrist treatment so that she become receptive to psychological management.

I personally believe that collective approach of a psychiatrist and psychologist helps to improve the situation. Consultation from a dietitian is not required.

Hope it helps you, you can ask again if you have more doubts.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Seikhoo Bishnoi


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