Orthorexia nervosa with hyponatremia, subcutaneous emphysema, pneumomediastimum, pneumothorax, and pancytopenia

Abstract

30-year-old male was admitted with general weakness and drowsy mental status. He had eaten only 3-4 spoons of brown rice and fresh vegetable without salt for 3 months to treat his tic disorder, and he had been in bed-ridden state. He has had weight loss of 14 kg in the last 3 months. We report a patient with orthorexia nervosa who developed hyponatremia, metabolic acidosis, subcutaneous emphysema, mediastinal emphysema, pneumothorax, and pancytopenia and we will review the literature. Also, we mention to prevent refeeding syndrome, and to start and maintain feeding in malnourished patients.

Keywords: hyponatremia; orthorexia nervosa; pancytopenia; refeeding syndrome; subcutaneous emphysema.

Fig. 1

Chest CT showed extensive soft tissue emphysema in his neck and chest wall , extensive mediastinal emphysema (A,B,C), small amount of right pneumothorax (A), and pericardial fluid (C).