Two Acute Liver Injuries in a Patient With Malnutrition

Amanda Su, Monica Choe, Jacqueline E. Birkness, Berkeley Limketkai, Po-Hung Chen


Chronic starvation and refeeding have been associated with liver injury (LI). We present a patient with anorexia nervosa who exhibited both phenomena of malnutrition-related LI. At presentation, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were elevated at 154 and 136 U/L, respectively, and rose rapidly to peaks of 750 and 638 U/L, respectively, as nutrition was introduced. Mechanisms of starvation-related LI include impaired degradation and secretion of lipids, as well as starvation-induced autophagy. LI during refeeding may be related to rapid increase in glucose availability. These phenomena are crucial to consider in patients with chronic starvation undergoing refeeding.

J Med Cases. 2021;12(8):315-318


Malnutrition; Refeeding; Hepatic steatosis; Liver injury

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