Anorexia Nervosa: The physiological consequences of starvation and the need for primary prevention efforts.
Bibliographic record
Abstract
CASE PRESENTATIONA 17-year-old girl was brought to the emergency department by her worried parents.The patient was described by her parents as having symptoms of fatigue, dizziness and syncope over the past few days.She also had no appetite, a weight loss of 11.4 kg over the past four months and a recent uncharacteristic pursuit to exercise.When the patient was further questioned, she complained of cold hands and feet, constipation, dry skin and hair, and headaches.Her social history revealed social withdrawal, depression, and irritability, as well as having difficulty concentrating and making decisions.Her performance at school had also fallen.The physical exam revealed a quiet, young girl who looked her age, was in no distress, but had cool peripheries.Her skin was slightly mottled in appearance, with some anhydrotic eczema of her extremities, and her blood pressure was difficult to auscultate.When obtained, it was lower than her usual values, at 84 systolic and 70 diastolic.Her pulse was 47 bpm, and irregularly irregular.Respiratory and abdominal examinations were normal.The patient however looked very underweight and thin.Her weight and height were 47 kg and 1.7 m, respectively; her calculated body-mass index (BMI) was 16.She also had a moderate loss of muscle mass and edema of her extremities.Further history taking from the patient, while alone, revealed that she had stopped menstruating seven months ago.There were no changes in sleep or any changes in bladder or bowel movements, and nausea and vomiting were denied.Her past medical history was remarkable for a stress fracture of her fibula and multiple admissions to hospital for depression, and she was also once admitted for suicidal ideation.Moreover, the patient denied any current laxative or diuretic use, and when asked about her diet, she stated that it consisted of yogurt and some fruit, with no meal at lunchtime while at school.Daily servings would not exceed a total of 750 kcal/day and her meals never contained any fat.She described herself as "fat…overweight" and her only pastime was exercising.When asked about her weight, she stated, "the more weight I lose, the more I wish to loose."She denied having any problems and explained that she was annoyed that her parents, friends, and teachers were concerned.It seems that the patient has very poor insight into her situation, and continues to perceive herself as healthy.Despite being aware that she is underweight, amenorrheic and bradycardic, she feels that she does not need to be in hospital.The social history revealed that the patient lives with her parents and two older siblings.When asked how her relationship is with her siblings, the patient replied, "I have never felt close to anyone…" The patient is a grade 12 student, and has considerable pressure from her parents to be an A student, and that they have very high expectations for her.She was involved in numerous extracurricular activities at school in the past; however, she is now preoccupied with her exercise goals, and has little time for other activities.English is a second language for the parents of the patient and there have been numerous problems in communication.There were parent-child relationship problems evident immediately on presentation.The mother has been unable to get the patient to eat at home; however, the family has been reluctant to have the patient admitted to hospital numerous times in the past.Family history revealed that a first cousin from the mother's side had been diagnosed with anorexia nervosa while in her teens.Laboratory values revealed anemia, leucopenia, hypoglycemia and numerous electrolyte disturbances.Her specific gravity in her urine was 1.005, indicating that she may have attempted to water load prior to
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".