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Germany. A 22-year-old woman who had suffered from anorexia for 10 years and had collapsed several times was admitted to a psychiatric clinic but died 2 days later.

At autopsy, the body of the woman had an extremely emaciated physique and weighed 22.6 kg (49.8 lbs) with a body length of 165 cm (5′ 4.9′′) and a body mass index (BMI) of 8.3 or very severely underweight.

Fig.1 A 22-year-old woman who had suffered from anorexia for 10 years.

No fatty tissue could be seen. Internal organs were small and appeared child-like. Excess accumulation of fluid (edema) in the brain. Dry body tissues. Urine alcohol concentration 0.04 ‰. Femoral blood: 20 ng / ml diphenhydramine, 0.00 ‰ BAK; 31.7 mmol / L (normal 29-42) HbA1c; 6.1 mg / l acetone; 23 μmol / L acetoacetate; 225 μmol / L β-hydroxybutyrate. The amount of diphenhydramine found in the femoral blood sample is in the therapeutic range.

The determination of the ketone bodies did not reveal any evidence of possible ketoacidosis. In contrast, the sums of the concentrations of glucose and lactate (Traub’s empirical formula) in the vitreous humor and liquor indicate hypoglycemia, with neither insulin nor synthetic insulins nor oral antidiabetic agents being detectable.

Fig.2 The body of the woman had an extremely emaciated physique and weighed 22.6 kg (49.8 lbs).

Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.

Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. Historians and psychologists have found evidence of people displaying symptoms of anorexia for hundreds or thousands of years.

Fig.3 No fatty tissue could be seen.

Although the disorder most frequently begins during adolescence, an increasing number of children and older adults are also being diagnosed with anorexia. You cannot tell if a person is struggling with anorexia by looking at them. A person does not need to be emaciated or underweight to be struggling. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.

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