Orthorexia Nervosa with Hyponatremia, Subcutaneous Emphysema, Pneumomediastimum, Pneumothorax, and Pancytopenia

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.

Changes of CA125 and PIIINP (Procollagen-3-N-terminal Peptide) in Peritoneal Dialysis Patients with Low GDP Solution / 대한신장학회잡지

BACKGROUND: The bioincompatability of the conventional peritoneal dialysis can be partly attributed to the presence of GDPs, which are generated during the heat sterilization. Formation of GDPs can be significantly reduced by the use of multi-chamber bag systems because high concentrated glucose is separated from alkaline lactate. In order to investigate whether multi-chamber bag system can improve the in vivo biocompatibility, we performed a randomized, prospective study comparing the multi-chamber bag system with the conventional PD system, measuring CA125 and PIIINP levels in the effluent dialysates as well as the other clinical and biochemical parameters. METHODS: Forty five patients who were stable on CAPD were enrolled randomly assigned to experiment group (n=27), and control group (n=18). Overnight effluent was collected for measurement of CA125 and PIIINP and the other clinical, biochemical parameters were compared including the number of peritonitis, the ultrafiltration volume. RESULTS: In patients treated with the multiple chamber bag system, there were significantly higher levels of CA125 and PIIINP from 1 month. No clinical and biochemical parameters influenced on their levels. The incidence of peritonitis or ultrafiltration volume did not differ between the two groups. CONCLUSION: Using the low GDP solution resulted in a better preservation of peritoneal mesothelial mass and an improvement of local peritoneal homeostasis, which are supposed to contribute to the biocompatibility of peritoneal dialysis fluid.