OUTPATIENT ANALYTIC ASSESSMENT OF ANOREXIA NERVOSA — THE IMPORTANCE OF VENOUS BLOOD GASES

Pires, Sofia Alexandra Pereira; Soares, Joana Costa; Luz, Alexandra Maria Branco da; Moleiro, Pascoal

doi:10.1590/1984-0462/2020/38/2018358

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Brasil

Revista Paulista de Pediatria

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Sumário

ORIGINAL ARTICLE • Rev. paul. pediatr. 38 • 2020 • https://doi.org/10.1590/1984-0462/2020/38/2018358 copy

OUTPATIENT ANALYTIC ASSESSMENT OF ANOREXIA NERVOSA — THE IMPORTANCE OF VENOUS BLOOD GASES

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate serum biochemical parameters’ evolution, especially venous blood gas (VBG), in anorexia nervosa (AN), correlating with clinical parameters.

Methods:

Retrospective study including out-patient AN adolescents, between January 2014 and May 2017. Three evaluations were compared: t1) first consultation; t2) consultation with the lowest body mass index (BMI) z-score and t3) with the highest BMI z-score.

Results:

A total of 24 adolescents (87.5% females) were included, mean age of presentation of 14.9±1.7 years, onset of symptoms 6.4±3.2 months before the first visit. In t1, BMI z-score of -1.91±1.11 kg/m² and ideal weight % of 84.3±9.2. Amenorrhea was present in 88%. In t2 the analytical alterations were: altered VBG in 100%, altered ferritin (72% elevated), altered thyroid function (53% with thyroxine decrease), dyslipidemia (31% elevation of high density lipoprotein, 25% hypercholesterolemia), elevation of urea (25%), elevation of alanine aminotransferase (14%), hypoglycemia (14%), anemia (9%). Respiratory acidosis was present in 91% in t1, 100% in t2 and 94% in t3. There was a significant decrease between t2 and t3 in mean pCO² (57.2 versus 53.6 mmHg; p=0.009) and mean HCO₃ (30.0 versus 28.8 mEq/L; p=0.023).

Conclusions:

Respiratory acidosis and increased ferritin were common in this group. Respiratory acidosis was the most frequent abnormality with significant pCO2 and HCO₃ variation in the recovery phase. VBG should be considered in AN evaluation, once it seems to be important in assessing the severity of the disease and its subsequent follow-up.

Keywords:
Anorexia nervosa; Adolescent; Malnutrition; Blood gas analysis

Parameters	First appointment
Age (years)	14.9±1.7 (variation 11–18)
Female/male (n)	21/3
Time since symptoms onset (months)	6.4±3.2 (variation 2–12)
Ideal weight %	84.3±9.2
BMI Z-score	-1.91±1.11
Severity^a
Mild	9
Moderate	7
Severe	4
Extreme	4
Amenorrhea (with menarche n=17)	15 (88%)
HR (bpm)
Mean±SD	58.3±13.7
% bradycardia	62.5
Systolic BP (mmHg)
Mean±SD	99.3±9.0
% hypotension	12.5

Parameters	t1	t2	t3	p-value^a
BMI score (Mean±SD)	-1.65±1.13	-2.41±1.31	-0.85±0.90	<0.001
HR (bpm)
Mean±SD	58.3±13.7	60.1±13.4	70.8±14.6	0.022
% bradycardia	62.5	60	23.8	0.022
Systolic BP (mmHg)
Mean±SD	99.3±9.0	97.3±10.1	102.2±11.2	0.031
% hypotension	12.5	20	10	0.031

	Reference values	t1 (n=24) (mean±SD) (normal value in %)	t2 (n=21) (mean±SD) (normal value in %)	t3 (n=21) (mean±SD) (normal value in %)	p-value^a
Hb (g/dL)	M (12.5–16.1) F (12–15)	13.6±1.5 88	13.4±1.6 86	13.1±1.2 81	0.395
Glucose (mg)	60–100	75.5±12.1 83	76.2±15.7 81	79.2±10.9 86	0.438
Total proteins (g/dL)	66-82	74.3±4.5 95	72.9±5.3 94	72.8±3.6 93	0.735
AST (U/L)	10–15Y(10–40) 16–19Y(15–45)	25.2±7.4 96	24.1±5.6 100	25.9±6.7 100	0.137
ALT (U/L)	5–45	26.3±11.7 92	27.5±12.9 86	32.7±21.7 85	0.366
LDH (U/L)	120–330	208.1±47.7 100	183.7±27.0 100	185.5±20.8 100	0.973
CK (U/L)	5–130	97.8±45.8 75	68.7±20.9 100%	72.4±26.8 100	0.715
Urea (mmol/L)	2.5–6.4	6.2±3.9 75	5.3±1.4 75	6.4±4.2 76	0.224
Creatinine (mg/dL)	10–14Y (0.31–0.88) 15–19Y (0.5–1.06)	0.8±0.2 96	0.7±0.1 100	0.7±0.1 95	0.051
HDL (mg/dL)	>35	58.4±11.3 100	57.0±9.23 100	61.3±14.6 100	0.332
LDL (mg/dL)	<130	98.6±39.4 80	99.8±41.7 69	84.7±28.2 94	0.025
TC (mg/dL)	<200	165.5±53.2 70	165.0±45.4 75	151.2±47.0 89	0.026
TG (mg/dL)	<150	72.3±22.9 100	68.6±24.6 100	71.9±0.4 94%	0.999
TSH (uUI/mL)	0.5–4.5	1.8±0.8 95	1.55±0.8 94	1.7±0.7 100	0.173
T4L (pmol/L)	9–25.7	9.9±1.3 84	9.3±1.6 47	8.9±2.3 53	0.748
K (mmol/L)	3.3–4.6	4.3±0.3 96	4.0±0.3 100	4.1±0.3 90	0.257
Na (mmol/L)	134–145	139.3±1.6 100	140.0±1.6 100	139.7±2.7 100	0.419
Ca (mmol/L)	2.2–2.7	2.4±0.4 86	2.3±0.5 79	2.2±0.4 89%	0.924
Mg (mmol/L)	0.6–0.95	0.9±0.1 77%	0.9±0.1 88	0.8±0.1 94	0.401
Phosphate (mmol/L)	12–15Y: 0.95–1.75; 16–19Y: 0.9–1.5	1.3±0.2 100	1.3±0.2 100	1.3±0.2 100	0.975
Ferritin (ng/mL)	M: 10–300 F: 10–70	160.8±159.9 (F: 163.2±169.4)^b 10	191.7±182.7 (F: 191.6±182.7)^b 14	70.0±39.6 (F: 74.2±40.9)^b 37	0.196 (F 0.196)
Venous pH	7.35–7.45	7.34±0.03^b 59	7.33±0.02^b 30	7.34±0.02^b 47	0.213
pCO₂ (mmHg)	<45	53.8±6.5^b 5	56.6±5.1^b 0	53.5±5.2^b 6	0.009
HCO₃ (mmHg)	22–29 (venous) 21–28 (arterial)	28.9±2.0 36	29.9±1.6 25	28.7±2.5 47	0.023

Venous blood gas analysis	t1 (n=22)	t2 (n=20)	t3 (n=17)	p-value
pH	7.34±0.03^a	7.33±0.02^a	7.34±0.02^a	0.213^b
pCO₂ (mmHg)	53.8±6.5^a	56.6±5.1^a	53.5±5.2^a	0.009^b
HCO₃ (mEq/L)	28.9±2.0	29.9±1.6	28.7±39.7	0.230^b
Respiratory acidosis	20 (91%)	20 (100%)	16 (95%)	NA
Compensated respiratory acidosis (pH 7.35–7.45 e pCO₂>45)	11 (50%)	7 (35%)	7 (41%)	NA
Non-compensated respiratory acidosis (pH <7.35 e pCO₂>45)	9 (41%)	13 (65%)	9 (53%)	0.453^c

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[1] *Corresponding author. E-mail: sofia.pires88@gmail.com (S.A.P. Pires).