starvation (redirected from preoperative starvation)

Starvation 

Definition

Starvation is the result of a severe or total lack of nutrients needed for the maintenance of life.

Description

Adequate nutrition has two components, necessary nutrients and energy in the form of calories. It is possible to ingest enough energy without a well-balanced selection of individual nutrients and produce diseases that are noticeably different from those resulting from an overall insufficiency of nutrients and energy. Although all foods are a source of energy for the human body, it is possible to consume a seemingly adequate amount of food without getting the required minimum of energy (calories). For example, marasmus is the result of a diet that is deficient mainly in energy. Children who get enough calories, but not enough protein have kwashiorkor. This is typical in cultures with a limited variety of foods that eat mostly a single staple carbohydrate like maize or rice. These conditions overlap and are associated with multiple vitamin and mineral deficits, most of which have specific names and set of problems associated with them.

• Marasmus produces a very skinny child with stunted growth.
• Children with kwashiorkor have body fat, an enlarged liver, and edema—swelling from excess water in the tissues. They also have growth retardation.
• Niacin deficiency produces pellagra characterized by diarrhea, skin rashes, brain dysfunction, tongue, mouth and vaginal irritation, and trouble swallowing.
• Thiamine (Vitamin B₁) deficiency causes beriberi, which can appear as heart failure and edema, a brain and nerve disease, or both.
• Riboflavin deficiency causes a sore mouth and throat, a skin rash, and anemia.
• Lack of vitamin C (ascorbic acid)—scurvy—causes hair damage, bleeding under the skin, in muscles and joints, gum disease, poor wound healing, and in severe cases convulsions, fever, loss of blood pressure, and death.
• Vitamin B₁₂ is needed to keep the nervous system working properly. It and pyridoxine (vitamin B₆) are both necessary for blood formation.
• Vitamin A deficiency causes at first loss of night vision and eventually blindness from destruction of the cornea, a disease called keratomalacia.

• Vitamin K is necessary for blood clotting.
• Vitamin D regulates calcium balance. Without it, children get rickets and adults get osteomalacia.

Causes and symptoms

Starvation may result from a number of factors. They include:

• anorexia nervosa, which is an eating disorder characterized by extreme calorie restriction
• intentional fasting
• coma
• stroke
• inability to obtain food (famine; child abuse; aftermath of war or other disaster; being lost in wilderness or desert areas)
• severe gastrointestinal disease

Since the body will combat malnutrition by breaking down its own fat and eventually its own tissue, a whole host of symptoms can appear. The body's structure, as well as its functions, are affected. Starved adults may lose as much as 50% of their normal body weight.

Characteristic symptoms of starvation include:

• shrinkage of such vital organs as the heart, lungs, ovaries, or testes, and gradual loss of their functions
• chronic diarrhea
• anemia
• reduction in muscle mass and consequent weakness
• lowered body temperature combined with extreme sensitivity to cold
• decreased ability to digest food because of lack of digestive acid production
• irritability and difficulty with mental concentration
• immune deficiency
• swelling from fluid under the skin
• decreased sex drive

Complete starvation in adults leads to death within eight to 12 weeks. In the final stages of starvation, adult humans experience a variety of neurological and psychiatric symptoms, including hallucinations and convulsions, as well as severe muscle pain and disturbances in heart rhythm.

In children, chronic malnutrition is marked by growth retardation. Anemia is the first sign to appear in an adult. Swelling of the legs is next, due to a drop in the protein content of the blood. Loss of resistance to infection follows next, along with poor wound healing. There is also progressive weakness and difficulty swallowing, which may lead to inhaling food. At the same time, the signs of specific nutrient deficiencies may appear.

Treatment

If the degree of malnutrition is severe, the intestines may not tolerate a fully balanced diet. They may, in fact, not be able to absorb adequate nutrition at all. Carefully prepared elemental diets or intravenous feeding must begin the treatment. A formula consisting of 42% dried skim milk, 32% edible oil, and 25% sucrose plus electrolyte, mineral, and vitamin supplements is recommended for the first phase of refeeding. The treatment back to health is long and first begins with liquids. Gradually, solid foods are introduced and a daily diet providing 5,000 calories or more is instituted.

Prognosis

People can recover from severe degrees of starvation to a normal stature and function. Children, however, may suffer from permanent mental retardation or growth defects if their deprivation was long and extreme.

Key terms

Anemia — Not enough red blood cells in the blood.

Anorexia nervosa — Eating disorder marked by malnutrition and weight loss commonly occurring in young women.

Cornea — The clear part of the front of the eye that admits light.

Kwashiorkor — Severe malnutritution in children caused by mainly by a protein-poor diet, characterized by growth retardation.

Marasmus — Severe malnutritution in children caused by a diet lacking mainly in calories. Can also be caused by disease and parasitic infection.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Starvation." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Btaiche, I. F., and N. Khalidi. "Metabolic Complications of Parenteral Nutrition in Adults, Part 1." American Journal of Health-System Pharmacy 61 (September 15, 2004): 1938-1949.

Nagao, M., Y. Maeno, H. Koyama, et al. "Estimation of Caloric Deficit in a Fatal Case of Starvation Resulting from Child Neglect." Journal of Forensic Science 49 (September 2004): 1073-1076.

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starvation /star·va·tion/ (stahr-va´shun) long-continued and extreme deprivation of food and resulting morbid effects.

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star·va·tion (stär-vshn)

n.

1. The act or process of starving.

2. The condition of being starved.

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starvation

[stärvā′shən]

Etymology: ME, sterven, to die

1 a condition resulting from the lack of essential nutrients over a long period (several days) and characterized by multiple physiologic and metabolic dysfunctions.

2 the act or state of starving or being starved. See also malnutrition.

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starvation,

n condition in which prolonged (for weeks or months) lack of nourishment depletes most of the body's fat stores and causes it to use protein for fuel.

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starvation,

n a condition resulting from the lack of essential nutrients over a long period and characterized by multiple physiologic and metabolic dysfunctions.

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starvation

long-continued deprival of food and its morbid effects. Hunger, loss of body weight and decreased muscle power and endurance occur early. Late stages include signs of milk yield drop, cessation of defecation and drinking, emaciation, loss of skin turgor without dehydration, weakness, slow heart rate and hypothermia.

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preoperative starvation

see preoperative fasting.

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starvation

Nutrition A condition resulting from prolonged global deprivation of food, which occurs in abnormal environmental conditions–eg, during war or famine, or in normal society through willful neglect of others–eg, children, the handicapped or elderly by parents, family, care-givers or guardians, or by self-neglect in the elderly, mentally feeble, anorectics, or those who, irrespective of means, choose to live in apparent poverty; without food and water, the body loses 4-5% of its total weight/day and few survive > 10 days; when water is provided, a starving person may survive up to 60 days Clinical Hypovitaminoses, malnutrition, ↓ subcutaneous fat with thin, dry and hyperpigmented skin stretched over bone prominences, atrophy of organs, marked attenuation of the GI tract, with an enlarged stone-laden gallbladder. See Fasting, Minnesota experiment Neurology A paucity of neurologic activity. See Motion starvation, sensory deprivation.