The pathological condition resulting from prolonged complete starvation and characterized by general exhaustion, metabolic disturbance, disruption of the work of almost all organs and systems in medicine is called alimentary insanity. The disease refers to social, i.e., due to socio-economic conditions.
Etiopathogenesis of nutritional senility
Pathology develops as a result of malnutrition. Despite the main factor, the disease affects people not only in countries with difficult economic conditions. Paying tribute to fashion, many are starving consciously. In developed countries, people suffer from anorexia - a severe degree of nutritional senility (alimentary dystrophy). Moreover, they do not stop even with noticeable changes in the body.
According to ICD-10, nutritional dystrophy has the code E41 and refers to severe malnutrition, with the accompanying insanity.
The disease is characterized by protein-calorie deficiency. In the early stages of fasting, the body maintains hemostasis by reducing energy expenditure. With a prolonged lack of nutrition, the body begins to expend fat reserves, tissue proteins, carbohydrates. Very quickly there is a decrease in glucose (25-40 mg%), as well as cholesterol and triglycerides. In parallel, the content of lactic acid increases. In urine, acetone appears in large quantities. In the later stages, a decrease in blood acidity is observed.
There are changes in protein metabolism. This leads to a disorder of those body functions that are realized with the participation of protein. Enzymatic deficiency occurs , which exacerbates dystrophy as a result of malabsorption of nutrients and their absorption.
The structure of the disease is constantly changing under the influence of changing living conditions and nutrition of people.
Pathology classification
In gastroenterology, a disease is classified by form and severity.
In shape:
- Cachectal - extreme exhaustion. This form is extremely unfavorable. Weight loss can be up to 50%.
- Edematous, characterized by swelling, including internal. The form has a favorable therapeutic prognosis.
In severity, 3 stages of alimentary dystrophy are distinguished:
- I. There is a slight decrease in weight, an increase in the frequency of deurination, with a constant volume of urine. Patients are thirsty and lack of salt - they overload the food. There is an increase in appetite and at times swelling appears.
- II. A sharp decrease in body weight. In the chest, abdomen and buttocks there is absolutely no fatty tissue. Deep folds and wrinkles appear on the face and neck. Patients are tormented by constipation, chilliness develops. The general condition worsens, muscle weakness appears, and performance is lost. Changes in the psyche are noted.
- III. Fat disappears completely. Severe weakness, a sharp breakdown, against this background, atrophy of skeletal muscles occurs. Dry skin with many folds. In edematous form - accumulation of exudate in the abdominal cavity. There is a hungry coma, pronounced changes in the psyche.
Factors affecting the development of the disease
The causes of nutritional dystrophy are nutrient deficiency, prolonged starvation. There is also an energy crisis, when much more energy is consumed than comes from food.
There are not so few factors due to which a person eats poorly or practically does not eat at all. But most often, prolonged fasting is due to the following.
- Socio-economic problems. Due to martial law, environmental disasters, forced imprisonment, a person cannot provide himself with a normal diet.
- Gastrointestinal pathologies, in which eating causes unpleasant, and sometimes painful sensations (heartburn, heaviness, bloating). The disease, accompanied by nausea, vomiting (ulcer, gastritis).
- Refusal of balanced food in favor of some kind of diet (vegetarianism, the Kremlin diet and others).
- Conscious refusal to eat in pursuit of an "ideal" appearance.
- Refusal of food in protest.
- Mental illness, in which a person does not eat without explanation (schizophrenia) or because he is afraid of eating (sitophobia).
How is the disease manifested?
The main pathological process in nutritional dystrophy is exhaustion. It is accompanied by characteristic clinical manifestations:
- constant feeling of hunger;
- polydipsia: thirst is associated with impaired water-salt balance;
- abnormal feeling of cold;
- muscle pain, starting from the lower extremities and gradually spreading to all groups;
- a feeling of heaviness in the abdomen, bloating;
- violation of the stool: painful constipation is replaced by watery diarrhea;
- frequent urination;
- constant weakness, breakdown;
- dizziness;
- lack of menstruation in women of childbearing age;
- mental disorder.
Complications
With alimentary dystrophy, the immune system is disturbed. The body cannot resist infections. The most common complication of dystrophy is tuberculosis, but, unfortunately, is not the only one.
- A sharp drop in blood pressure and a deterioration in the blood supply to organs (collapse).
- Hungry coma. In the initial stages, it is accompanied by a feeling of hunger, dilated pupils, fainting.
- Hypochromic anemia.
- Dysentery occurs against a background of decreased secretory functions of the gastrointestinal tract.
- Pneumonia.
Alimentary insanity in children
Dystrophy can occur at any age. For a child, a lack of nutrients in the body, especially protein, is more dangerous than for an adult.
Protein deficiency occurs in two severe forms - nutritional insanity and kwashiorkor. The latter is characterized by a lack of protein in the diet with a sufficient amount of fats and carbohydrates. Kwashiorkor is usually observed in children aged 1-4 years.
The word kwashiorkor in translation from the language of the indigenous inhabitants of West Africa means "excommunicated from the mother." The disease is most common in undeveloped countries, where food is mainly fruits and vegetables and health care is almost undeveloped.
Due to a lack of protein in the child’s menu, the intestinal glands are disrupted, blood albumin, and colloid-osmotic plasma pressure are reduced. As a result, cell hyperhydration occurs, characterized by edema.
Malabsorption develops due to damage to the intestinal mucosa. Frequent bowel movement promotes enhanced excretion of lactic acid, acidosis develops. Pancreatic fibrosis is formed, fatty degeneration of the liver. In conditions of deficiency of protein and vitamins, anemia increases.
What is the danger of dystrophy in childhood?
The child is characterized by the lack of formation of the immune system. In children with dystrophy, the protective functions of the body are practically inactive, complications of the disease are common.
- Clerophthalmia. Insufficient hydration of the eyes develops against a background of deficiency or non-absorption of vitamin A.
- Hypothermia is characterized by pallor, lethargy, in severe cases, blueness of the skin and mucous membranes.
- Hypoglycemia. A critically low level of glucose in the blood contributes to the development of disorders of the central nervous system of the child and can cause death.
- Subcom.
- Heart failure. Decreased myocardial contractility leads to inferior blood supply to organs and, as a result, their atrophy.
How is the diagnosis carried out?
The basis for the diagnosis of nutritional dystrophy in adults and children is a thorough history and a thorough examination of the patient. Physical examination is to identify and assess the general condition:
- determining how much weight loss is progressing;
- temperature measurement allows you to determine the presence of hypothermia;
- assessment of the condition of the skin: color, humidity;
- examination of the eyes and the area around them: dark circles under the eyes indicate a lack of nutrients in the body.
To determine the degree of dystrophy and the presence of complications, laboratory tests are prescribed. The reduced indicators of red blood cells and hemoglobin determine the form of anemia, the level of glucose - the stage of alimentary insanity.
Diagnostics includes instrumental examination:
- ultrasound scanning of internal organs;
- fluoroscopy;
- fibrogastroduodenoscopy - a study of the digestive tract using endoscopic equipment;
- colonoscopy.
Therapies
Treatment of alimentary dystrophy at any stage begins with the normalization of nutrition, rest. Under stationary conditions, patients are placed in a well-ventilated warm room. In no case should patients with dystrophy come into contact with infectious patients.
In the first degree of pathology, fractional multiple meals are prescribed (light, quickly digestible food). In grade II and III, patients are prescribed entits and parenteral administration of glucose solutions (40%) every 2 hours, 50 ml each. Initially, the approximate daily calorie intake is 3,000 kcal, gradually brought to 4,500 kcal per day. The lack of fluid is made up by the drip of various solutions.
Infectious complications are treated with antibacterial drugs. With the development of seizures, 10 ml of potassium chloride solution (10%) is injected into a vein.
Pathology monitoring
The prognosis of alimentary insanity completely depends on the timeliness of seeking medical help. In the later stages, the disease is irreversible and fatal. Less often, when the conditions for the intake of nutrients into the body change, the pathology from stage III passes into II, and subsequently to clinical recovery.
Do not forget about the causes of starvation. If they are caused by fanaticism and phobias, the patient should also visit a psychiatrist. In case of complications, the prognosis depends on the severity of concomitant pathologies.
According to statistics, women are the most resistant to dystrophy. The most difficult to tolerate the disease is the elderly and children.
Disease prevention
The main preventive measure is a nutritious diet with a sufficient balanced amount of vitamins and minerals proteins. If hunger is a consequence of human-independent circumstances (war, environmental disaster), try to leave the scene of the disaster if possible. If it doesn’t work, try to be less nervous (this will not improve), consume as much protein as possible, even if it is of non-animal origin. It is found in legumes, nuts, seeds.