In this article we will discuss about Starvation:- 1. Hormone Production of Starvation 2. Clinical Features of Starvation 3. Psychological Disturbances 4. Infections 5. Treatment 6. Prognosis.
Contents:
- Hormone Production of Starvation
- Clinical Features of Starvation
- Psychological Disturbances Caused by Starvation
- Infections of Starvation
- Treatment for Starvation
- Prognosis of Starvation
1. Hormone Production of Starvation:
a. There is impaired secretion of pituitary gonadotrophins and testosterone as well as 17-oxy-steroid concentration in plasma falls.
b. Plasma Insulin level is reduced because the stimulating substances, glucose and amino acids, are not absorbed during fasting.
c. The secretion of pituitary growth hormone tends to be increased and this favours fat mobilization.
d. In prolonged starvation, the concentration of 3, 5, 3′- triiodothyronine falls which is responsible for the reduced metabolism.
2. Clinical Features of Starvation:
a. The patients are thin having loss of weight.
b. The hair is dry and lustreless.
c. The eyes are dull and sunken.
d. The skin is thin, dry, and inelastic.
e. Dirty brown splotches of pigmentation may appear over the face and trunk.
f. Polyuria at night is a frequent troublesome symptom.
g. Oedema first starts in the face when lying down and the ankle oedema is found when the patient gets up and walks about.
h. The blood pressure is low; the diastolic pressure may be impossible to estimate, while the systolic pressure may be as low as 70 mm of Hg. In severe cases, the pulse rate is often below 40/min.
3. Psychological Disturbances Caused by Starvation:
a. The mind is never fixed for long on single subject except the desire for food. Existence of mental restlessness.
b. The patient becomes self-centred and indifferent to the troubles of others.
c. The patient is worried and sensitive to noise and other petty irritations which may make him quarrelsome.
d. In the last stages of starvation, the personality may completely disintegrate. A mother may even steal from her child.
4. Infections of Starvation:
a. Starvation patients often suffer from infections—malaria, cholera, typhus, pneumonia, gastroenteritis.
b. Cancrum oris, an infective gangrene of the mouth eroding the lip and cheeks, is a dreadful catastrophe which occasionally occurs in famines both among children and adults.
c. The atrophied intestinal glands and the paper-thin walls of the digestive tract are unable to digest and absorb properly even a bland diet.
d. In almost all famines, there is outbreak of diarrhoea without bacteriological organisms.
5. Treatment for Starvation:
a. Most famine victims, owing to alimentary dysfunction, cannot consume large quantities of food. The patient’s desire for food is immense and no guide to his digestive capacities. Food intake should necessarily be limited.
b. The choice of food is vital. Many starving people in the prison camp of World War II died from diarrhoea and collapsed after they had been given bully-beef, baked beans which they could not readily digest. Only bland foods can be tolerated by the thin-walled intestines lacking essential digestive enzymes.
c. Frequent small feeds of skimmed milk, 100 ml or so at a time-as often as the patient is willing and able to take them- is a good way to avert death from starvation. This requires constant personal attention and nursing care.
d. A variety of mild flavouring essences may be useful to stimulate the appetite. Slightly sour foods are usually acceptable.
e. Starving patients may tolerate moderate amounts of fat or edible oils, which provide a larger energy intake. There may be a temporary increase in oedema with re-feeding, so the intake of salt should be restricted.
f. A time may come in severe starvation when the patient refuses all food. The outlook is then very grave. Nasogastric or parenteral feeding provides the only hope.
6. Prognosis of Starvation:
a. Most people with primary under-nutrition recover rapidly, once they have a free access to food. Appetite may be sufficient. Over 5,000 k cal/day may be consume with a weekly gain in weight of 1.5 to 2 kg.
b. In some patients, even after careful nursing and a good diet, low blood pressure and diarrhoea may persist. If, after one or two weeks, they show little improvement, this suggests strongly that irreversible changes in the myocardium or small intestine have developed and that the prognosis is poor.
After any severe famine there are some who may linger on in this condition for many months if supported by good medical and nursing skill, death rather than recovery is the usual end.