A fifteen-year-old female is rushed to the Emergency Department upon discovery of the young girl unconscious at home. The girl is hot to the touch, has very rapid breathing and her breath has a strange smell, much like fruit. Her mother reported that the girl had been unwell for a few days, complaining of stomach pain and nausea. The patient’s blood pressure is lower than normal and she appears dehydrated. Further, her heart rate is quite low (in the range of 46bpm). Additionally, blood work shows a deficiency in electrolytes as well as an elevation in basophils. Urinalysis shows an

A fifteen-year-old female is rushed to the Emergency Department upon discovery of the young girl unconscious at home. The girl is hot to the touch, has very rapid breathing and her breath has a strange smell, much like fruit. Her mother reported that the girl had been unwell for a few days, complaining of stomach pain and nausea. The patient’s blood pressure is lower than normal and she appears dehydrated. Further, her heart rate is quite low (in the range of 46bpm). Additionally, blood work shows a deficiency in electrolytes as well as an elevation in basophils. Urinalysis shows an elevation in ketone bodies. Upon closer inspection, physicians note excessive tooth wear as well as what appear to be sores in the girl’s esophagus.

Based upon these observations, physicians inquire as to the girl’s eating patterns. Mom is vague – the patient is 15 and thus not home for most of the day. At night she picks at her food and complains of extra weight and always needing to diet. However, mom does comment that in the last few months her daughter has been moody and has lost weight. The cause of the myriad of symptoms appears to be an eating disorder and the patient is quite sick with ketoacidosis as well as bradycardia.