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Case details

A 23 –year- old female was brought for consultation by her mother who was troubled by her daughter’s continuous fatigue, dizziness and loss of weight. The patient was 6 feet 2 inches tall and weighed 100 pounds.

Laboratory results revealed – Blood glucose 50 mg% and elevated ketones.

Further questioning revealed that the young woman had been virtually fasting for 4 months hoping to obtain a ‘skinny figure’ as a prelude to a career in modeling.

What is the problem with this female?

What is the cause of hypoglycemia?

Case discussion

The patient shows many signs of Anorexia Nervosa (AN), which is an eating disorder. The etiology of AN is unknown but appears to involve a combination of psychological, biologic, and cultural risk factors. The condition is characterized by aversion to food that leads to a state of fasting and emaciation. Patients often have a distorted image of their own body weight or shape and are unconcerned by the serious health consequences of their low weight. As weight loss progresses, the fear of gaining weight grows; dieting becomes stricter; and psychological, behavioral, and medical aberrations increase.

After several months of near starvation, the blood glucose in these patients is maintained by gluconeogenesis, primarily from amino acids mobilized from tissue proteins. The patients develop potential vitamin deficiencies. Liver glycogen is exhausted in the first day of fasting. Gluconeogenesis depletes the supply of oxaloacetate, which is essential for the entry of acetyl CoA into the citric acid cycle. Consequently, the liver produces large quantities of ketone bodies, which are released into the blood. After several weeks of starvation, ketone bodies become the major fuel of the brain. The impaired conversion of amino acids in to glucose is responsible for producing hypoglycemia in these patients. A person’s survival time is mainly determined by the size of the triacylglycerol depot.

The diagnosis of AN is based on the presence of characteristic behavioral, psychological, and physical attributes. Psychotherapy, medication, or hospitalization are required to treat these patients.


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2 Responses to Hypoglycemia

  • Vj says:

    starvation induced hypogylemia

    less glucose – fat fueled into oxidation – acetyl co a byproduct – too much load – diverted for ketone bodies production –

    ketonuria , note urine is almost neutral since it combines with bases and gets excreted

    liver glycogen stores get depleted in just 1 day!

    if there was no history of fasting
    this cud have been a complication of type I D.M.


  • Yes. Vj you are right, good attempt but read some more details in my post. Good luck keep trying. Sounds good.