Hypoglycemic coma in a patient with anorexia nervosa coincident with acute exacerbation of liver injury induced by oral intake of nutrients.

A 33-year-old woman with anorexia nervosa was admitted because of severe malnutrition. Acute liver injury was observed soon after the beginning of oral intake. She was prohibited from eating for 10 days and treated with parenteral nutrition until liver dysfunction was improved. One week after resuming oral intake, she presented severe hypoglycemic coma along with acute exacerbation of hepatocytic injury. Clinical laboratory data suggest that insufficient gluconeogenesis in acute liver injury was involved in severe hypoglycemia. We should be careful of severe hypoglycemia in patients with anorexia nervosa after resuming oral ingestion when signs of liver damage are detected, although hypoglycemic coma is uncommon in anorexia nervosa.