Hypoglycemia and death in anorexia nervosa.

Several deaths in patients with anorexia nervosa have been ascribed to 'inanition'. The proximate cause of death from inanition has not been established. There are few previous reports of life-threatening hypoglycemia in anorexia nervosa. We participated in the care of two severely cachectic women with anorexia nervosa who were in coma with serum glucose levels of 8 and 14 mg/dl, respectively. Both patients became alert after administration of intravenous glucose. Both were found to have pneumonia at the time of the hypoglycemic event. While the mechanism of the hypoglycemia is unknown, it may be related to the suppression of gluconeogenesis by infection in the setting of reduced substrate, depleted fat stores and decreased catecholamine release.