A 14-year-old girl is brought to the emergency department by her parents, who are very concerned about her behavior. The patient refuses to give any history. Laboratory tests show:
Na+: 132 mEq/L
K+: 3.1 mEq/L
Cl-: 90 mEq/L
Glucose: 115 mg/dL
Blood urea nitrogen: 30 mg/dL
Creatinine: 0.8 mg/dL
Her serum amylase level is mildly elevated, and arterial blood gas analysis shows metabolic alkalosis. Her erythrocyte sedimentation rate is within normal limits.
Which of the following is the most likely diagnosis?
127150 : handeep
A.Anorexia nervosa
B.Bartter's syndrome
C.Bulimia nervosa
D.Crohn's disease
E.Syndrome of inappropriate ADH secretion
between A and C really! lol
i meant either it's A or C!
why not A
put reasoning. ... we have to discuss and clear our concepts doctors
well...i don't know, elevated serum Amylase level, i don't know if we see that with A.
Bullimea..may be some mouth pathology involved, hence elevated Amylase..
i know it's like shooting an "arrow in the dark" kind of deal with that explanation!
C....because pt induces vomiting leading to meta. alkalosis
Plus serum glucose elevated...don't see that with Anorexics i think!
amylase goes up may be due to parotids inflamation,i guess.
The correct answer is C. 63% chose this.
This teenaged patient presents with hypokalemic, hypochloremic metabolic alkalosis, consistent with frequent vomiting; in this clinical scenario, the physician must consider bulimia nervosa. Frequent purging behavior of any kind can produce fluid and electrolyte abnormalities, most frequently hypokalemia, hyponatremia, and hypochloremia. The loss of stomach acid through vomiting may produce a metabolic alkalosis (elevated serum bicarbonate), and the frequent induction of diarrhea through laxative abuse can cause metabolic acidosis. Some individuals with bulimia nervosa exhibit mildly elevated levels of serum amylase, probably reflecting an increase in the salivary isoenzyme (and the classic swollen glands causing chipmunk facies).
A is not correct. 28% chose this.
Although patients with anorexia nervosa can become hypokalemic (from vomiting), hyponatremia, hypochloremia, and metabolic alkalosis are not common with this disorder. Obtaining protein and albumin levels would be useful in diagnosis, as they are typically very low in these nutritionally deficient patients.
B is not correct. 6% chose this.
Bartter's syndrome is an autosomal recessive renal tubular disorder distinguished by severe hypokalemia (1.5-2.5 mEq/L), hypochloremia, metabolic alkalosis, and hyperreninemia associated with a normal blood pressure. The underlying renal abnormality results in excessive urinary losses of sodium, chloride, and potassium. While the potassium level is low in this patient, it is not as severely low as seen in Bartter's syndrome.
D is not correct. 1% chose this.
Crohn's disease is a chronic inflammatory condition of the gastrointestinal tract characterized by transmural inflammation and skip lesions. As such, although diarrhea in Crohn's disease can cause electrolyte disturbances, pertinent laboratory findings would include an elevated erythrocyte sedimentation rate.
E is not correct. 2% chose this.
Hyponatremia (sodium level less than 135 mmol/L) is a cardinal sign of the syndrome of inappropriate ADH secretion. This has to be accompanied by hypo-osmolality of less than 280 mOsm/kg. Hypotonic hyponatremia does not present unless the patient is drinking and retaining water. This is successfully corrected by fluid restriction. The diagnosis is one of exclusion, and the physician would not see a metabolic alkalosis.
Bottom Line:
Eating disorders are associated with various electrolyte disorders. Frequent purging behavior of any kind can produce fluid and electrolyte abnormalities, most frequently hypokalemia, hyponatremia, and hypochloremia. Metabolic acidosis or alkalosis may be present, depending on whether diarrhea or vomiting dominates the clinical picture.