Alimentary dystrophy (hunger disease, protein-free edema, etc.)

Alimentary dystrophy (hungry disease, protein-free edema, etc.) is a disease of prolonged malnutrition characterized by general exhaustion, a disorder of all metabolic forms, dystrophy of tissues and organs with a violation of their functions.

Etiology, pathogenesis. Inadequate intake and absorption of nutrients due to exogenous as well as endogenous causes (neoplastic, cicatricial narrowing of the esophagus, pylorus, syndromes of insufficiency of digestion, absorption). Important not only absolute, but also relative (disproportionate to the physical work) reduction in caloric content of food, qualitative changes in the diet, especially deficiency of proteins (mainly animals), fats; Lack of essential amino acids, fatty acids and vitamins (especially fat-soluble). With prolonged nutritional deficiencies, hypoproteinemia, dystrophic changes in various organs and tissues occur, the function of many organs is disrupted, and polyglandular insufficiency arises. Dystrophic changes in the wall of the digestive tract and digestive glands are accompanied by progressive impairments of their functions and further exacerbate changes in metabolism in the body.

Symptoms, course. There are 3 stages of alimentary dystrophy. Stage I is characterized by a decrease in diet, pollakiuria, increased appetite, thirst, desire for increased consumption of table salt. The general condition of patients does not suffer dramatically. In the II stage, along with a clear weight loss, the general condition of patients worsens, muscle weakness develops, work capacity is lost, hypoproteinemic edema on the legs, moderate hypothermia of the body appear. There is an increased appetite and thirst, poly- and pollakiuria, initial dystrophic changes in various organs, changes in the psyche. Stage III is characterized by cachexia, complete disappearance of subcutaneous fat, muscle atrophy, severe weakness (until complete inability to perform independent movements), apathy, pronounced changes in the psyche, paresthesia, polyhypovitaminosis, signs of cardiac, liver failure, anemia, painful constipation, often bedsores. Then develops pronounced hypothermia (body temperature decreases in some cases to 30 ° C), hypotension, acidosis; In many cases a hungry coma develops or sudden death occurs.

The course of the disease in the absence of emergency measures progressing until the development of hunger coma. The death of patients in stage III of alimentary dystrophy occurs in the form of either a slow gradual dying, or the so-called accelerated death (during the day) caused by the attachment of an infectious disease, as well as sudden death at the time of even a small physical strain. Complications: joining of infectious diseases (pneumonia, tuberculosis, intestinal infections, etc.).

Treatment. Observance of complete physical and mental rest in the early days, full, rich in vitamins and protein nutrition with a gradual expansion of the diet. Simultaneously, intravenous injection of plasma, protein hydrolysates, vitamins. Symptomatic therapy: the fight against acidosis, cardiac and vascular insufficiency, diuretics (with pronounced edema), anabolic steroid hormones. Gradual expansion of the regime, therapeutic exercise.

At a hungry coma - in / in the introduction of 50 ml of 40% glucose solution every 2 hours, blood substitutes, plasma, protein hydrolysates, warming of the patient. With convulsions-iv injection of 10% calcium chloride solution (10 ml), when removing from the coma-hot sweet tea, then frequent fractional feeding of the patient (in small portions) using the most easily digestible food.

With alimentary dystrophy caused by violation of upper patency of the digestive tract, first of all - elimination of the cause (tumor or cicatricial stenosis of the esophagus, achalasia of the cardia) or palliative surgery (gastrostomy, etc.)