The Turkish Journal of Pediatrics
2009 , Vol 51 , Num 6
Edema can be a handicap in treatment of anorexia nervosa
1Adolescent Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, and 2Department of
Child Psychiatry, Yeditepe University Faculty of Medicine, İstanbul, Turkey
Anorexia and bulimia nervosa are common in western civilized countries.
They are among the psychiatric disorders in that they are often accompanied
by a variety of life- threatening physical abnormalities. These patients need a
close follow-up of the pediatrician in collaboration with the psychiatrist since
the changes in bodily functions affect the psychiatric therapy. The challenge
to the physician is to use the traditional tools of medicine to diagnose and
treat these physical abnormalities using careful medical history, a complete
physical examination and appropriate laboratory testing. Peripheral edema
is seen as a physical finding in anorexia nervosa (AN) and it is not rare.
The estimated frequency is up to 20% among adolescent patients. Peripheral
edema in this setting can be easily confused as weight gain. There are five
possible mechanisms for its occurrence: hypoproteinemia, electrolyte imbalance,
hormonal changes, rapid refeedings, and abuse of laxative, diuretics and diet
pills. Patients with eating disorders may ingest a large number of drugs in
an attempt to control their weight. We present a case of a female adolescent
with AN and peripheral edema who terminated her psychiatric treatment
during the refeeding phase because of the unbearable anxiety caused by this
edema that affected her body image dramatically. With this case study, we
point out the importance of assessing peripheral edema and discriminating
it from true weight gain.
Keywords :
anorexia nervosa, peripheral edema, weight gain.