Growing Concerns Over Recurrent Acidotic Episodes
Hello, I’m feeling extremely anxious about my health, especially given that I didn’t sleep well last night as these thoughts linger in my mind. To provide some background, I’m a 38-year-old woman weighing 99 pounds and standing at 162 cm. Recently, I found myself in the hospital on two separate occasions, where I was diagnosed with "starvation ketoacidosis." Each stay lasted 5 to 7 days, requiring extensive interventions with glucose and nasogastric feeding to stabilize my condition. During one episode, I even experienced hypoglycemia while on an extended fasting regimen. This all came about after a sudden relapse of my anorexia nervosa. Throughout my life, I have never been diagnosed with diabetes, and my A1C levels have consistently remained normal. However, I have frequently experienced significant issues with reactive hypoglycemia. What troubles me most is that starvation ketoacidosis seems to be quite uncommon. I find myself questioning why I am experiencing this condition while others who restrict their calorie or carbohydrate intake do not seem to face the same issue. My mind wanders to the possibility of a more serious underlying condition. My stepmother, a retired diabetes specialist, suggested that I consult a metabolic expert after reviewing some of my blood work, which indicated that my insulin levels were on the lower end, while my C-peptide levels appeared borderline high. The concern I have regarding my situation stems from how alarmed the medical staff appeared to be. During my second hospitalization, I spent hours in the emergency department (though not in resuscitation), with a blood glucose reading of 31 mg/dL. The medical team was astonished that I was still alert and able to converse at that level. I was in an acidotic state that day, and it was triggered when my ketone levels rose above 6 mmol/L, prompting my inability to eat. After a frustrating four-hour standoff with a bowl of yogurt, I eventually called the health advice hotline, which led to an ambulance being dispatched. I understand the straightforward explanation: I simply haven’t been eating enough. However, I have struggled with eating disorders for an extended period and have yet to come across others sharing this specific challenge, nor has it ever been a topic of assessment during regular medical check-ups (which include blood tests, ECGs, weight management, vitals, and DEXA scans every couple of years). I suspect I may have dealt with this previously without a formal diagnosis since healthcare providers never investigated it further. Any perspectives or advice you could provide would be greatly appreciated. My anxiety is growing as I find it increasingly difficult to maintain my condition adequately to avoid another hospital stay. I met with the eating disorder team last week and am currently awaiting details about a treatment plan. Given my present BMI and the limited availability of beds, it seems unlikely that inpatient care will be possible at this moment. Background: rheumatoid arthritis, osteoarthritis, anemia, anorexia nervosa, right hip replacement, migraines, OCD, autism, PTSD. Current Medications: Etanercept, paracetamol, amitriptyline, tramadol, gabapentin, fluoxetine, omeprazole, propranolol, estrogen patches.
Answers (1)
9/8/2025, 8:10:59 PM
OpenHealth AI
I understand that you’re feeling anxious about your health, especially with concerns over recurrent acidotic episodes and your struggles with eating disorders, particularly anorexia nervosa. It’s important to acknowledge the complexity of your situation, and I want to provide you with some structured, actionable advice to help you manage your symptoms and reduce your anxiety.
Main Points:
- Starvation ketoacidosis can occur due to severe caloric restriction, especially if you're not eating enough to meet your body's energy needs.
- Staying hydrated and balanced in nutrition is critical. Regular meal planning may help you avoid drastic fluctuations in blood glucose levels.
- Establishing an open communication channel with your healthcare team (including the eating disorder team) is vital for coordinated care and effective management.
Explanation:
Starvation ketoacidosis is a rare but serious condition that occurs when your body is unable to utilize glucose effectively, often because of insufficient food intake. In your case, it seems to be related to your history with anorexia nervosa and the episodes of hypoglycemia you’ve experienced. The low insulin and borderline C-peptide levels may signal issues with how your body processes food, particularly under conditions of caloric deprivation.
Your experiences, while uncommon, highlight the need for careful management—especially since your hospital stays have shown that you can have severe reactions to fasting. It's understandable to be concerned about recurring episodes, but it's essential to focus on practical steps to prevent them rather than getting lost in worry about underlying conditions.
Actionable Steps:
-
Dietary Regularity:
- Aim for small, regular meals throughout the day and include a mix of carbohydrates, proteins, and fats to stabilize blood sugar levels.
- Consider working with a dietitian experienced in eating disorders to develop a meal plan that feels manageable for you.
-
Hydration:
- Make sure you're drinking enough fluids. Dehydration can exacerbate your condition and increase the risk of acidotic episodes.
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Monitoring Blood Glucose:
- Keep track of your blood sugar levels, especially if you feel symptoms like dizziness, shakiness, or confusion. This can help you detect any issues early.
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Support System:
- Continue regular meetings with your eating disorder team and ensure that they are aware of your history with ketoacidosis and hypoglycemia for tailored support.
- Engage a trusted friend or family member to assist you in meal planning and to provide encouragement.
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Mental Health Focus:
- Given your background with anxiety, consider incorporating relaxation techniques such as mindfulness or breathing exercises to help manage anxiety surrounding food intake and health.
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Plan for Emergencies:
- If you suspect you might have another episode, have a care plan in place. This may include having glucose tablets handy or contacts for emergency intervention.
It's positive that you’re initiating a treatment plan with your eating disorder team. While inpatient care may not be available right now, focus on these actionable steps to create a routine that can help stabilize your condition and reduce anxiety. Remember, you’re taking important strides in addressing your health, and seeking support is a vital part of that process. If you have further questions or need clarification on any of the steps, feel free to ask.
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