Weight loss in an adolescent girl

A 15 year old girl who had been previously fit and well presented to the child and adolescent mental health services (CAMHS) team with weight loss, irregular menstrual periods, excessive exercise, restriction of energy intake during the day, and binging during the evening, followed by vomiting. Her symptoms had been present for a year, since her father had experienced a myocardial infarction. Clinically her symptoms were in keeping with anorexia nervosa, as shown by her completed eating disorder questionnaire.1 Her body mass index (BMI) was 16 and her weight for height was 85% of the median (50th centile) for age and sex. She had a distorted body image, believing her stomach and ankles were too fat, and she had an extreme fear of gaining weight.

She was admitted to an acute medical unit as an emergency after developing severe dehydration with hypotension, tachycardia, dizziness, low energy, and inability to concentrate.

She was found to have hypokalaemia, hypophosphataemia, high bicarbonate levels, and a high amylase concentration. She was given fluid replacement and her electrolyte balance was corrected. CAMHS and the specialist eating disorders team followed her up in the community.