Alimentary dystrophy
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Alimentary dystrophy (alimentary marasmus) is a disease caused by prolonged fasting and leading to severe protein and energy deficiency.
Alimentary dystrophy is common among residents of developing countries, as well as among the population living in a war zone. However, in recent years, this disease has ceased to be a rarity among residents of prosperous countries. The desire to have an "ideal" figure sometimes becomes the reason for almost complete refusal to eat. This condition is called anorexia. Long-term adherence to a low-calorie diet causes disruption of metabolic processes in the body and contributes to the development of alimentary dystrophy. In fact, anorexia is an alimentary dystrophy of neuropsychic origin.
Alimentary dystrophy is a severe form of protein-energy deficiency
Causes and risk factors
Prolonged starvation leads to the development of alimentary dystrophy, which means insufficient (that is, not covering the physiological expense) intake of energy and basic nutrients into the body.
Fasting can be caused by:
- ecological disaster;
- military conflict;
- deforming scars of the esophagus;
- irrational diets.
Hypothermia and hard physical labor contribute to the aggravation of disorders of energy metabolism in the body.
During fasting, the body initially uses glycogen stores to cover energy deficits, then fat. After their depletion, interstitial proteins are used as a source of energy - this is the starting point for the development of alimentary dystrophy.
Dystrophic processes occur first in muscle tissue and skin, then affect the internal organs. The brain and spinal cord, kidneys and heart are drawn in last. In advanced cases, the decay processes are so pronounced that even active treatment does not completely normalize the metabolism and achieve the correct ratio of anabolism and catabolism.
The consequence of severe degrees of alimentary dystrophy is a deficiency of vitamins, disorders of water and electrolyte metabolism. All this becomes the cause of serious damage to the immune system and the development of cardiovascular insufficiency, which, in turn, leads to death.
Forms of the disease
There are two forms of alimentary dystrophy:
- Edematous. The presence of external and internal edema (effusion pleurisy, pericarditis, ascites) is characteristic. This form of the disease has a more favorable course.
- Dry (cachectic). Her therapy presents a lot of difficulties.
Disease stages
There are three stages of alimentary dystrophy:
- Lightweight. Efficiency is preserved, body weight is slightly reduced compared to normal. Increased appetite and thirst, increased urination, weakness.
- Average. Patients lose their ability to work, they can only serve themselves. A significant decrease in the concentration of protein in the blood leads to the appearance of edema. Periodically, there are attacks of hypoglycemia associated with a sudden drop in serum glucose levels.
- Heavy. The patients are severely emaciated. They cannot move and usually do not even try to get out of bed. The outcome of this stage of alimentary dystrophy is the development of a hungry coma.
Symptoms
Alimentary dystrophy develops gradually. For its appearance, it is required that nutrients do not enter the body for a long time in the required amount. The first symptoms of alimentary dystrophy include:
- drowsiness;
- decreased performance;
- weakness;
- irritability;
- polyuria;
- increased appetite;
- constant feeling of thirst;
- the need to eat salted foods.
Drowsiness and loss of energy are the first symptoms of alimentary dystrophy
Initial symptoms are usually not perceived by patients as a serious problem, so they do not seek medical attention. The disease gradually progresses and passes into the next stage, which is characterized by:
- severe general weakness;
- significant disability;
- low body temperature;
- dryness and flabbiness of the skin (which resemble parchment and hang in pronounced folds);
- low blood pressure;
- constipation;
- bradycardia;
- amenorrhea (in women);
- decreased potency (in men);
- infertility.
The most striking clinical picture of alimentary dystrophy develops at the last stage of the disease, when almost all body functions fade away. At this stage, the following are observed:
- complete absence of subcutaneous fat layer;
- flabbiness and thinning of skeletal muscles;
- impossibility of independent movement;
- increased fragility of bones;
- mental disorders;
- pancytopenia - a sharp decrease in the content of all basic cells in the peripheral blood (platelets, leukocytes, erythrocytes);
- hypoproteinemia - a decrease in the concentration of protein in the blood;
- a tendency to hypoglycemia.
At this stage of alimentary dystrophy, sooner or later a hungry coma develops. This is due to low blood glucose levels, which does not cover the energy needs of the brain. The clinical picture is as follows:
- pallor of the skin;
- unconsciousness;
- dilated pupils;
- decrease in body temperature;
- disturbances in the rhythm and depth of breathing;
- decreased muscle tone;
- seizures (possible);
- a sharp decrease in blood pressure;
- pulse of weak filling, practically not detected.
Against the background of an increase in respiratory and cardiovascular insufficiency, cardiac arrest may occur.
Diagnostics
The diagnosis of alimentary dystrophy is established on the basis of characteristic signs of the disease with an indication of prolonged fasting. To confirm it, as well as to exclude other pathologies with a similar clinical picture, a laboratory and instrumental examination is shown, including:
- general blood test with calculation of the leukocyte formula;
- detailed biochemical blood test;
- Ultrasound of internal organs;
- magnetic resonance imaging or computed tomography.
To diagnose alimentary dystrophy, general and biochemical blood tests are taken
Alimentary dystrophy must be differentiated from diseases that also cause depletion of the body:
- thyrotoxicosis;
- pituitary disorders;
- diabetes;
- tuberculosis;
- malignant neoplasms.
Alimentary dystrophy differs from these diseases in the following symptoms:
- dysfunction of the endocrine system;
- decrease in body temperature;
- increased appetite and thirst;
- characteristic changes in the skin and muscle wasting.
Treatment
Treatment of alimentary dystrophy begins with the normalization of diet, sleep and rest. Patients are hospitalized in a separate ward, possible contact with other patients is minimized.
At the initial stages of alimentary dystrophy, fractional therapeutic nutrition is organized, including easily digestible dishes in the diet.
In case of an illness of moderate severity, enteral nutrition is carried out using special nutritional mixtures (enpits). If necessary, it is supplemented with parenteral nutrition, that is, intravenous drip administration of solutions of amino acids, glucose, electrolytes and fat emulsions. At the beginning of therapy, the daily caloric intake should be 3000 kcal. Then, with good digestibility, the calorie content is gradually increased and brought to 4500 kcal per day. The diet must necessarily contain a sufficient amount of protein (at the rate of 2 g per kg of body weight per day), including of animal origin.
In case of severe alimentary dystrophy, in addition to the organization of nutrition, correction of violations of the water-electrolyte balance, transfusion of blood and its components (erythrocyte mass, leukocyte mass, albumin, plasma) are necessary.
Fractional nutritional therapy is prescribed at the initial stages of alimentary dystrophy
When a secondary infection is attached, antibacterial therapy is prescribed with broad-spectrum drugs.
With the development of a hungry coma, which, in fact, is hypoglycemic, a hypertonic glucose solution is injected intravenously.
Patients with alimentary dystrophy need long-term rehabilitation, not only physical, but also psychological. It should last at least six months from the moment the patient is discharged from the hospital and be carried out jointly by doctors of several specialties (gastroenterologist, physiotherapist, psychotherapist).
Possible complications and consequences
With alimentary dystrophy, immunity decreases. As a result, a secondary infection often joins, for example, pneumonia, tuberculosis. The lack of a full-fledged immune response creates the prerequisites for the development of a septic state.
With alimentary dystrophy during significant physical exertion, the patient may experience pulmonary embolism, leading to a rapid death.
Forecast
If untreated, alimentary dystrophy becomes the cause of the death of the patient.
Correctly conducted therapy in many cases quickly leads to an external improvement in the patient's condition, but at the same time, he has metabolic disorders. It can be very difficult to achieve complete restoration of impaired functions: treatment sometimes takes several years.
Prevention
Prevention of alimentary dystrophy consists in active promotion of proper and rational nutrition, refusal of low-calorie diets.
Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
