Exhaustion is an extreme degree of weight loss (more than 20%), in which the work of various organs and systems is disrupted. The condition is often accompanied by symptoms of nervous exhaustion, weakness, adynamia. Exhaustion of the body occurs with anorexia, chronic gastrointestinal diseases, cancer and other types of intoxication. To determine the factors that caused the disorder, ultrasound and X-ray imaging methods, neurological examination, laboratory tests are prescribed. To normalize body weight, adequate oral or parenteral nutrition is necessary in combination with etiotropic therapy for the causes of weight loss.
Causes of exhaustion
The condition is more common in young women. The first signs of the disorder are constant dissatisfaction with your body and the desire to lose weight by any means. Girls with anorexia begin to limit themselves in food, adhere to strict diets, against which they lose up to 10-15% of body weight, cause vomiting after eating. Rapid exhaustion occurs, the appearance and quality of the body changes — the skin becomes dry and flabby, gathers into folds, hair falls out, nails begin to layer. There is constant weakness and fatigue. At the same time, the patient continues to consider herself fat and follows a diet.
Progressive exhaustion of the body causes severe changes in all internal organs, which indicates the transition to the cachectic stage of anorexia. Weight loss is 20-30% or more, complete refusal of food intake is possible. Subcutaneous fat disappears, all ribs, pelvic bones, collarbones are well contoured. Due to severe metabolic disorders, extensive edema forms, amenorrhea occurs, sexual desire disappears. When the first signs of anorexia and exhaustion appear, it is important to provide the patient with qualified medical care.
Narrowing of the esophageal lumen and the lack of food promotion into the stomach are common causes of exhaustion, which are caused by post-traumatic strictures of the organ, volumetric formations. At the initial stage, food partially enters the stomach, so the general condition remains satisfactory, weight loss is no more than 5%. As esophageal stenosis progresses, the exhaustion of the body worsens, each attempt to eat ends in vomiting, so patients deliberately refuse to eat. Sharp weight loss is accompanied by swelling and an increase in the size of the abdomen due to the emerging ascites.
Signs of exhaustion occur against the background of dyspeptic manifestations: vomiting several times a day, heaviness in the abdomen after eating, prolonged diarrhea. Symptoms are caused by malabsorption syndrome, in addition, patients reduce portions of food, as a result of which the diet is depleted of proteins, vitamins. There is rapid weight loss, flabbiness and hyperpigmentation of the skin. Lack of vitamins causes menstrual function disorder in women and decreased potency in men, diffuse alopecia and fragility of nail plates are characteristic. Exhaustion is often caused by such reasons as:
- Intestinal diseases: duodenitis, enteritis, enterocolitis.
- Pathology of other gastrointestinal organs: chronic pancreatitis, chronic hepatitis and cirrhosis of the liver.
- Bacterial infections: bacterial overgrowth syndrome (BOS), some forms of escherichiosis and salmonellosis.
- Celiac disease.
- Consequences of surgical interventions: dumping syndrome after gastric resection, postcholecystectomy syndrome.
When toxic compounds and bacterial waste products accumulate in the blood, typical symptoms of exhaustion appear: progressive weight loss against a background of decreased appetite, deterioration of the skin and hair, sexual dysfunction. The clinical picture develops more often with prolonged subfebrile body temperature, characterized by profuse sweating and a sharp pallor of the skin. The lability of emotional reactions is quickly manifested, neurotic states are formed. Common causes of exhaustion of the body:
- Chronic infections: brucellosis, tuberculosis, chlamydia, mycoplasmosis.
- Purulent processes: abscesses, osteomyelitis, chroniosepsis.
Depletion of the body is possible with neoplasms of any localization, which is associated with cancer intoxication, increased catabolism (processes of splitting substances). Patients lose more than 20% of their body weight in a short time, which is accompanied by a complete loss of working capacity, a characteristic appearance: fatty tissue is practically absent, the skin is flabby, pale with a yellowish tinge, sparse hair, flaky nails. With neoplasms of the gastrointestinal tract, the development of cancerous cachexia occurs faster, which is due to mechanical obstacles to the promotion of food and impaired absorption of nutrients.
The clinical picture is dominated by a weight loss of 2-6 kg per month, combined with general exhaustion of the body. Weight loss occurs evenly, the proportions of the body are preserved. The skin becomes thinner and becomes very dry (like tissue paper), sweating decreases up to anhidrosis, hair falls out in the armpits and on the pubis. Dystrophic processes in the internal organs are manifested by hypotension, frequent constipation, amenorrhea. Similar symptoms are observed with exhaustion in women after childbirth due to Sheehan syndrome.
Progressive weight loss occurs in the 3rd stage of heart failure. The causes of exhaustion are dystrophic changes in the myocardium and the entire muscle tissue, concomitant damage to the mucous membrane of the small intestine. At the initial stages, the weight does not change, which is due to severe edema and ascites, then there is a weight loss of more than 15% of the initial indicators. Weakness and adynamia are increasing, sometimes patients cannot even get out of bed. The typical appearance of the patient includes a thin face and upper torso, a large belly with stretched skin due to ascites, swelling of the legs.
Most often, the depletion of the body occurs when an abnormal amyloid protein is deposited in the gastrointestinal tract. At the same time, the process of digestion and absorption of food is disrupted, since the cells of the small intestine do not perform their function. Patients with amyloidosis report significant weight loss occurring against the background of persistent diarrhea and decreased appetite. When the liver is involved in the process, it is characterized by the appearance of dull pains on the right in the hypochondrium after eating, vomiting with bile. Exhaustion can be complicated by amyloidosis of the kidneys, which is accompanied by pronounced loss of proteins.
The main causes of sudden weight loss and emaciated appearance are the addition of secondary bacterial and viral infections. The weight loss of AIDS patients reaches 25% or more of the initial values, the skin looks pale with a waxy tinge. Exhaustion is aggravated by the presence of purulent foci in the body, chronic diarrhea. Libido decreases, menstrual function is absent in women. The onset of HIV encephalopathy is manifested by signs of nervous exhaustion – irritability, apathy, then cognitive abilities (memory, attention, understanding of what is happening) deteriorate.
- Genetic enzymopathies: fructosemia, glucose-galactose intolerance, Hartnup’s disease.
- Collagenoses: systemic lupus erythematosus, scleroderma, rheumatoid arthritis.
- Forced starvation.
- Other endocrine disorders: decompensated form of diabetes mellitus, chronic insufficiency of the adrenal cortex, hypothyroidism.
- Acantholytic pemphigus.
- Exogenous intoxication: accidental or occupational poisoning with lead, arsenic, mercury.
- Vitamin deficiency: scurvy, beriberi, pellagra.
Diagnostics of exhaustion
To clarify the cause of exhaustion, it is usually necessary to consult a therapist who is responsible for the initial examination and excludes the most typical factors causing weight loss. A comprehensive study of the state of internal organs, assessment of neurological and mental reactions is necessary. The following methods have the greatest diagnostic value:
- Sonography. First, an ultrasound of the abdominal cavity is performed, during which signs of inflammatory and dystrophic processes, the presence of stenoses and bulky formations are revealed. The motility of the stomach and intestines is evaluated. Ultrasound of the thyroid gland and adrenal glands is performed, mammary glands are examined in women to exclude cancer.
- X-ray method. In case of exhaustion, the state of the gastrointestinal tract is necessarily checked, for which a series of X-rays with contrast are performed. The method is effective for stenoses and tumors of the esophagus, allows you to assess the rate of progress of the chyme. In order to exclude pituitary lesion, a targeted X-ray of the Turkish saddle is recommended.
- Endoscopic examinations. EDS helps to study in detail neoplasms and strictures in the upper part of the digestive canal, which often cause exhaustion of the body. During the procedure, a test with methylene blue is performed to detect metaplasia, as well as an endoscopic biopsy of suspicious formations to exclude the oncological cause of cachexia.
- Blood tests. The degree of depletion of the body is judged by the level of protein reduction in the biochemical analysis of blood. Determination of the concentration of nitrogen metabolism products and basic electrolytes makes it possible to assess the severity of damage to internal organs. The level of tropic hormones of the pituitary gland, liberins and statins of the hypothalamus is measured.
- Neurological examination. The examination is indicated in the presence of signs of nervous and physical exhaustion. They examine the level of consciousness and cognitive capabilities, check muscle tone, coordination of movements. To exclude severe lesions that are accompanied by refusal of food, CT and MRI of the brain are prescribed. The functional activity of brain cells is recorded on an EEG.
If the symptoms of exhaustion of the body are accompanied by “small signs” of oncological pathology (fatigue, lethargy, general malaise, anemia), it is necessary to examine the blood for cancer markers, perform additional instrumental procedures – CT of the abdominal cavity and chest, body scintigraphy. All patients are screened for HIV infection. When exhaustion is combined with a dysmorphic state, a psychiatrist’s consultation is required to exclude a neurotic or psychotic cause of the disorder.
Treatment of exhaustion
Help before diagnosis
The appearance of symptoms of exhaustion is usually caused by serious causes that cannot be eliminated by self-treatment. In most cases, emergency medical care is required to prevent critical irreversible changes in internal organs. If the symptoms occur against the background of anorexia nervosa, and the patient does not consider himself sick, relatives and close friends can arrange a specialist consultation or take the person to a specialized clinic.
The main task of treatment is to fill the nutritional needs. With a mild form of exhaustion of the body, the caloric content of the diet is gradually increased, the diet should contain a large amount of protein, complex carbohydrates and vitamins. In severe situations, probe feeding or parenteral administration of special solutions of amino acids and fat emulsions is indicated. Anorexia requires individual and group psychotherapy. For etiotropic therapy of conditions that cause exhaustion, the drug treatment regimen includes:
- Enzymes. To improve the digestive processes in chronic enteritis and pancreatitis, enzyme agents are prescribed that replace the function of the pancreas. Taking probiotics allows you to normalize the microflora, prevent the development of SIBR.
- Antibacterial agents. Therapy is performed for chronic infections that cause intoxication and catabolic reactions. Drugs are selected based on the properties of the pathogen. Antibiotics and antiprotozoal medications are recommended for the treatment of opportunistic infections with AIDS.
- Hormonal drugs. If the symptoms of exhaustion are caused by endocrine pathology, replacement therapy is used. Glucocorticoids, levothyroxine and sex hormones are most often prescribed, and pituitary tropic hormones are sometimes used for panhypopituitarism.
- Cardiotropic medications. Cardiac glycosides, antianginal drugs (calcium channel inhibitors, beta blockers) fully or partially compensate for heart failure. Thiazide and potassium-sparing diuretics are effective for the elimination of edema.
- Cytostatics. The drugs are indicated both for severe connective tissue diseases, amyloidosis, and for the treatment of the tumor cause of cachexia. Medications and doses are selected individually, taking into account the localization of the pathological process and the presence of metastases.
When detecting a malignant neoplasm as a cause of exhaustion, radical interventions are needed to remove neoplasia along with the affected tissue and lymph nodes. In stage 1-2 cancer, organ-preserving operations are the method of choice. In advanced cases, advanced techniques are used. For the treatment of exhaustion of the body, which is caused by a violation of the patency of the esophagus, stenting of the narrowed area is performed. If necessary, esophagoplasty is performed with gastric or intestinal transplants.