Adolescent Female with Severe Food and Fluid Restriction

Case at a Glance

A 14-year-old female presents with a 5-day history of severe food and fluid restriction, raising concerns for eating disorder with potential self-harm ideation.

Patient's Story

A 14-year-old female patient was brought to medical attention by a concerned friend who reported that the patient had been refusing food and fluids for approximately 5 days. The friend indicated that for the first 3-4 days, the patient consumed no food or liquids whatsoever. On days 4-5, there was minimal intake of food and fluids. The patient's current location and immediate family contact information were initially unknown to the reporting friend, creating challenges in ensuring immediate medical intervention.

Initial Assessment

The patient presents with acute dehydration and malnutrition secondary to voluntary food and fluid restriction. Given the duration and severity of the restriction, immediate medical evaluation was deemed necessary. The differential diagnosis includes eating disorders (anorexia nervosa, ARFID), depression with suicidal ideation, or other psychiatric conditions affecting appetite and self-care.

The Diagnostic Journey

Initial concerns focused on the patient's immediate physical safety due to prolonged fasting and dehydration. The case required coordination with family members and mental health professionals to assess both the physical and psychological aspects of the presentation. Evaluation included assessment for signs of severe dehydration, electrolyte imbalances, and psychiatric risk factors.

Final Diagnosis

Severe food and fluid restriction in an adolescent female, requiring immediate medical intervention and psychiatric evaluation to rule out eating disorder and assess for self-harm risk.

Treatment Plan

Immediate medical stabilization with IV fluids and electrolyte monitoring. Psychiatric consultation to evaluate for eating disorders and suicidal ideation. Family involvement in treatment planning. Referral to specialized eating disorder treatment if indicated. Crisis intervention resources provided including suicide prevention hotline (988).

Outcome and Follow-up

Patient required immediate medical attention for rehydration and nutritional support. Long-term follow-up with mental health professionals specializing in adolescent eating disorders was recommended. Family education and support services were initiated to prevent future episodes.