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Query: UMLS:C0015672 (fatigue)
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The authors relate the results of studying intellectual work fitness in patients with anorexia nervosa (in the stage of cachexia) receiving the vitamin-like drugs carnitine and cobamamide. It has been shown that the long-term food deprivation leads to a reduction of intellectual work fitness, lability of productivity, fluctuations in the work quality, appearance of latent fatigue. In spite of the fact that standard nonspecific treatment ameliorates intellectual work fitness, it does not lead to its normalization. The use of carnitine and cobamamide in the course of nonspecific treatment results in the reduction of the time spent on task implementation, a rise of the work rate as compared to the control group. However, this does not fully remove latent fatigue and does not bring about complete recovery to normal of intellectual work fitness. The combined use of carnitine and cobamamide eliminates fluctuations in the work rate and normalizes the scope and productivity of intellectual work.
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PMID:[Effects of carnitine and cobamamide on the dynamics of mental work capacity in patients with anorexia nervosa]. 135 43

Persons who contacted the Anorexia/Bulimia Association of Norway for information and stated that they had an eating disorder were asked to participate in this questionnaire study. The answers from the 32 women who fulfilled the DSM-III-R criteria for bulimia nervosa are presented. Usually the women's eating problems had started in the teens after a period of voluntary dieting. The mean duration of bulimia nervosa was six years. 31% had a history of anorexia nervosa. At the time of the study almost all had normal body weight, but nevertheless felt overweight. 78% practised self-induced vomiting, 22% used laxatives and 16% used diuretics to reduce weight. Depressive and anxiety symptoms were common in connection with the overeating episodes, but also more generally, which interfered with everyday life. Somatic symptoms (abdominal pain, diarrhoea, constipation, dyspepsia, headache, dry mouth and eyes, parotid gland swelling, muscular symptoms, fatigue, and oligomenorrhoea) were also common.
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PMID:[Bulimia nervosa and self-reported symptoms. A questionnaire study among 32 women with bulimia nervosa]. 147 Nov 6

A 28-yr-old, female marathon and "fitness" runner presented with leg swelling, fatigue, and loss of endurance. She was running an hour or more daily in addition to regular biking and swimming. She was an instructor in a fitness center. For 2 months prior to her leg swelling, she had increased fatigue and decreased exercise tolerance. She had been seen previously for a slow healing hamstring strain. She had not had a menstrual period for over 2 yr and had refused evaluation. She admitted to very low dietary intake, which she had always denied. She was worried about her body fat. She denied recent blood loss, diuretic or cathartic use, and induced vomiting. She appeared malnourished, pale, and older than her stated age. Her weight was 41.4 kg. Her blood pressure was 90/60, and her pulse was 100 per minute. She had pitting edema of the lower extremities to the knees. The diagnosis of anorexia nervosa was made and will be discussed.
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PMID:Malnutrition in a compulsive runner: a case conference. 176 50

The effects of carnitine and cobamamide were studied at the unspecific stage of anorexia nervosa treatment. Carnitine and cobamamide accelerated the amelioration of the patients' somatic state (body weight gain, gastrointestinal functions normalization). Experimental psychological technique of involved deciphering discovered that latent fatigue disappeared and mental performance sharply increased under carnitine and cobamamide treatment. Experimental model of anorexia nervosa was used for electron microscopy and morphometry of neocortical tissue structure after starvation period and in feeding rehabilitation with carnitine and cobamamide. These drugs were shown to promote cerebral mass growth, increase in neocortical layers thickness, pyramidal neurons volume, that led to full restoration of normal structure of neocortex. The data provide a basis suitable to recommend carnitineand cobamamide to treat patients with relevant anorexia.
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PMID:[Clinico-experimental substantiation of the use of carnitine and cobalamin in the treatment of anorexia nervosa]. 272 26

More than 100 patient-years' experience has been acquired in the treatment of 133 patients with ambulatory home total parenteral nutrition (TPN) between May 1974 and December 1983. Indications for chronic or permanent home TPN include short bowel syndrome, malabsorption, scleroderma, and vasoactive intestinal polypeptide syndrome. Indications for acute or temporary home TPN include Crohn's disease, malignancies, gastrointestinal fistulas, ulcerative colitis, anorexia nervosa, and numerous other disorders. Eighty-two patients in the acute group were treated primarily with percutaneously placed standard subclavian catheters and 51 patients in the chronic group have been treated thus far with implanted silicone rubber, Dacron-cuffed catheters for a cumulative total of 38,939 patient days. Of the 125 implanted catheters, 115 were placed in the superior vena cava and ten in the inferior vena cava for an average duration of 250 catheter-days, the longest single catheter remaining in situ for more than 8 1/2 years. Catheter-related sepsis occurred 33 times with the implanted catheters, or once every 2.6 catheter-years. One hundred and fourteen temporary catheters were placed percutaneously in the superior vena cava via a subclavian vein for an average duration of 68 days, the longest single catheter remaining in situ for 213 days. Catheter-related sepsis occurred seven times, equivalent to one episode per 3 catheter-years. Total catheter-related complications were quite infrequent and were directly related to duration of catheterization. They included venous thrombosis (12), clotted catheter (11), catheter failure or rupture (8), catheter compression (5) and inadvertent catheter removal (4). Twenty-six catheters were repaired or spliced in situ when the external segment was accidentally damaged or deteriorated secondary to long-term material fatigue. One remarkable patient has been maintained exclusively by TPN originally as an inpatient and subsequently as an outpatient for the entire 13 years of his life.
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PMID:100 patient-years of ambulatory home total parenteral nutrition. 642 31

Skeletal muscle function, body composition (total body nitrogen and total body potassium) and standard parameters of nutritional assessment were measured in six severely depleted patients with primary anorexia nervosa, both on admission and during oral refeeding. The function of the adductor pollicis muscle was assessed by electrical stimulation of the ulnar nerve. On admission muscle function was markedly abnormal in the patients with anorexia nervosa (n = 6) compared with normal subjects (n = 22), with a significant increase in the force of contraction at 10 Hz, with a mean +/- SEM of 48.0 +/- 3.7% and 28.8 +/- 1.2%, respectively (p less than 0.001). There was slowing of the maximal relaxation rate, 6.6 +/- 0.6% and 9.6 +/- 0.2%, respectively (p less than 0.001) and increased muscle fatigue 18.6 +/- 5.9% and 3.5 +/- 0.8%, respectively (p less than 0.01). Initially, the mean serum albumin was normal (4.0 +/- 0.1 g/dl), although there was evidence of severe depletion of somatic protein stores, with a low total body nitrogen and creatinine-height index. Within 4 wk of oral refeeding, maximal relaxation rate and muscle fatigability were restored to normal, and within 8 wk all parameters of muscle function were normal. During the study total body nitrogen increased by only 13% and was still 19.4% below the predicted normal total body nitrogen, whereas total body potassium increased by 32% and body fat by 46%. Normalization of muscle function may be related to restoration of muscle electrolytes rather than repletion of body nitrogen.
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PMID:A comparison between muscle function and body composition in anorexia nervosa: the effect of refeeding. 688 Oct 81

The evaluation of the nutritional status of patients with anorexia nervosa is of great utility when establishing guidelines for specific and appropriate dietary programs to face nutritional deficiencies and thus favoring their recovery. The nutritional status of patients was evaluated by means of anthropometric, biochemical, and dietetic parameters in a group of 78 anorexics who followed a psychiatric and nutritional therapy, 57 in an ambulatory basis and 21 as in-patients. Anthropometric parameters (weight and body mass index) showed a severe depletion of the nutritional status, particularly in in-patients. Only 25% of patients had a body mass index higher than 18 and 5% had values within normal ranges. While biochemical indexes (hemoglobin, hematocrit, red blood cells, mean corpuscular volume, total proteins and vitamins: thiamine, riboflavin, B6, ascorbic acid, alpha-tocopherol, retinol and beta-carotene) were within normal ranges in most cases, there were variable percentages of patients with marginal values and clearly deficient for group B vitamins: thiamine (79 +/- 11 U/l; P25 = 70 U/l), riboflavin (884 +/- 160 U/l; P5 = 640 U/l) and B6 (309 +/- 131 U/l; P25 = 227 U/l). The study of the diet showed a marked lack of energy supply (only 25% of patients had their needs satisfied (P75 = 101%) and minerals (iron, magnesium, and zinc). Intake of proteins and vitamins was, in general, satisfactory. Critical points to be considered in refeeding are energy and mineral deficiencies.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Guidelines for the dietetic treatment of patients with anorexia nervosa based on an assessment of their nutritional status]. 778 56

Three cases are reported of hypoglycemia manifested by profound sinus bradycardia and fatigue, which responded to i.v. dextrose with prompt normalization of the cardiac rhythm. The cases involved 3 different patients and disease processes: a young female who had anorexia nervosa and profound malnutrition; an elderly, nondiabetic male who subsequently experienced a transient ischemic attack: and a patient who had diabetes mellitus managed with chronic, subcutaneous insulin administration. It is vitally important that the emergency physician recognize unusual clinical manifestations of hypoglycemia and fully evaluate such scenarios when hypoglycemia may occur. Untreated, hypoglycemia may result in significant chronic morbidity, and rarely, in death. Bradyarrhythmias--particularly sinus bradycardia--should be added to the list of potential clinical manifestations of hypoglycemia.
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PMID:Hypoglycemia manifested by sinus bradycardia: a report of three cases. 881 87

Pregnancy in patients with anorexia nervosa is rarely suspected. Amenorrhea is invariably present, often accompanied by sensations such as a bloated abdomen, nausea, vomiting, and fatigue. The detection of conception in anorectic patients is often delayed. Two extreme cases of belated recognition of pregnancy (at Weeks 25 and 26) in anorectic patients are described: Both had been amenorrheic prior to conception, had no notion of pregnancy, and in both, discovery was incidental. Termination of pregnancy, requested by one of the patients, was unfeasible at this gestational age. Pregnancy in patients with eating disorders is elusive, prone to complications, and should be considered when symptoms are suggestive.
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PMID:Delayed detection of pregnancy in patients with anorexia nervosa: two case reports. 895 30

In order to clarify the differences in mood states between anorexia and bulimia nervosa, the Profile of Mood States (POMS) with tension-anxiety, depression, anger-hostility, vigour, fatigue and confusion scales was administered to 32 female patients with anorexia nervosa (age range 14 to 32 years, mean age 20 years), 49 female patients with bulimia nervosa (age range 15 to 33 years, mean age 23 years) and 410 'normal' female subjects (age range 14 to 35 years, mean age 23 years). The scores on the depression, fatigue and confusion scales for both anorexia and bulimia nervosa and those on the tension-anxiety and anger-hostility scales for bulimia nervosa were significantly higher than those for the control subjects. The score on the fatigue scale for bulimia nervosa was significantly higher than that for anorexia nervosa. Moreover, the result of the multiple logistic regression analysis including all of the POMS scales indicated that the fatigue scale significantly discriminated between the two disorders. Fatigue mood appears to be a principal indicator for differentiating between the two disorders.
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PMID:Fatigue mood as an indicator discriminating between anorexia nervosa and bulimia nervosa. 954 8


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