Nutritional marasmus is a disease characterized by severe protein and more often more pronounced energy deficiency. The manifestations can be very different, the main ones are body weight loss of more than 20% (or a BMI of less than 16), dry and flabby skin, brittle hair and nails, lethargy, drowsiness and weakness, increased appetite. Diagnosis is based mainly on anamnesis, a combination of objective and subjective signs, as well as on the exclusion of other diseases. The treatment is complex, it consists in establishing nutrition and restoring the reserves of nutrients, vitamins and trace elements in the body.
E41 Nutritional marasmus
Nutritional marasmus is a social disease that can develop as a result of forced or conscious starvation. Today, people suffer from nutritional marasmus not only in developing countries, during wars and catastrophes – and this is more than half a million people. Many are willing to starve themselves consciously in pursuit of a beautiful figure and to please their complexes. However, the disease can have serious consequences, up to a fatal outcome. With prolonged fasting, the absence of essential substances in the body can cause irreversible changes in metabolic processes. In developed countries, it is increasingly possible to hear about cases of anorexia – and this is the same nutritional marasmus of severe degree.
Causes of nutritional marasmus
The cause of nutritional marasmus is prolonged fasting, during which the body receives insufficient amounts of nutrients and energy. At the same time, their relative insufficiency is also taken into account: when the intake of calories does not correspond to their consumption. Starvation can occur for various reasons (war, environmental disaster and other cases when a person is forced to not get food for a long time; diets; narrowing and scarring of the esophagus, etc.), but the aggravation of the process is provoked by hard physical labor, hypothermia.
It should be noted that the development of dystrophy is possible only with prolonged energy starvation. At the same time, glycogen and fat reserves are first completely depleted in the body, then reserves of interstitial protein are used to ensure the basic metabolism. First of all, the processes of dystrophy begin in the skin, muscles, then internal organs are involved, last of all – vital (heart, kidneys and brain). At some point, the processes of catabolism take such a form that a fatal outcome becomes inevitable even at the beginning of full-fledged treatment.
In the last stages of the disease, the body’s reserves of vitamins and minerals are depleted, the immune system ceases to function. The fatal outcome usually occurs either from heart failure, or from an infection that has joined against the background of significant suppression of immunity.
In practical gastroenterology, it is customary to divide nutritional marasmus by both forms and severity. The form of the disease is divided into cachectic (dry) and edematous. The cachectic form has a more unfavorable course. The edematous form is characterized by the development of common edema, including internal edema (ascites, pericarditis and pleurisy), this form is better treatable.
According to the severity of the disease, there are three stages.
- At the first stage, there is a slight decrease in body weight, preservation of working capacity, along with the appearance of complaints of more frequent urination, thirst and increased appetite, chilliness and weakness.
- At the second stage, there is a significant emaciation with loss of working capacity. Such patients can still serve themselves, but they are practically incapable of any work. Edema may appear, protein levels significantly decrease, and there are often episodes of lowering blood glucose levels.
- At the third stage, patients can no longer move independently and get out of bed, they are severely exhausted. When a hungry coma appears, even in a patient who had previously maintained working capacity, they talk about the third stage of the disease.
Nutritional marasmus symptoms
Pathology develops gradually, often the patient may not realize that he suffers from this ailment. Usually, the first signs of cachexia appear only after a long restriction of the intake of not only calories, but also protein, fats, essential amino acids and vitamins (more often fat-soluble) into the body. The first symptoms may not be noticed or regarded as dangerous: increased urination, polyuria (an increase in the daily volume of urine), weakness and irritability, decreased performance, constant drowsiness. Thirst often worries, increased appetite. One of the specific symptoms is a tendency to eat salt.
If the nutrition is not adjusted, the disease progresses and moves to the next stage. At the same time, the skin becomes very flabby and dry, sagging in folds, resembles parchment. It becomes very difficult to perform any physical work, the general condition suffers quite a lot. The first signs of dystrophy and dysfunction of internal organs appear (constipation and other dyspeptic manifestations, heart disorders, endocrine disorders – menstruation disappears in women, infertility occurs). There is a tendency to lower the temperature. The heartbeat is reduced, the pressure is low. There may be changes in the psyche.
The last stage of the disease is characterized by a vivid manifestation of the extinction of all body functions. There is no subcutaneous fat layer, the muscles become very thin and flabby. A person is no longer able to move independently at the third stage. There is a decrease in the level of all blood cells (erythrocytes, leukocytes, platelets), the immune system is suppressed. There is a very low level of protein in the blood, a tendency to lower glucose levels. The reserves of vitamins and minerals are completely depleted, the bones become brittle. Since the body triggers catabolism (destruction) of its own proteins, toxic products of their decay begin to accumulate in the blood. This leads to an even greater deterioration of the condition, the appearance of pronounced mental disorders (the result of the action of decay products on the brain). Usually, in the last stages of the disease, even the beginning of treatment and nutrition cannot prevent a sad outcome.
The most severe condition that develops in the last stages of nutritional marasmus is a hungry coma. It occurs due to a significant decrease in blood glucose levels and the inability to provide the brain with the necessary amount of energy. The clinic of this condition is quite bright: sudden loss of consciousness, pallor and coldness of the skin, wide pupils. The body temperature is significantly lowered. Breathing is shallow, may be rare and irregular. Muscles without tone, seizures may develop. The pulse is practically undetectable, weak, the pressure is low. If you do not provide timely assistance, death will occur from cardiac arrest and respiration.
Also, the course of nutritional marasmus can be complicated by the addition of various infections (intestinal, tuberculosis, pneumonia, sepsis). Often death occurs from embolism of the pulmonary artery with blood clots (PE), with overstrain during physical exertion.
The diagnosis can be made on the basis of a thorough history collection and examination of the patient. If there are indications of prolonged fasting in the anamnesis, then there are symptoms characteristic of nutritional marasmus and laboratory indicators (detailed clinical and biochemical blood test, signs of dystrophy of internal organs by ultrasound, CT or MRI), and other diseases have been excluded, the diagnosis is not difficult.
Nutritional marasmus should be differentiated with other diseases that can lead to exhaustion of the body:
- oncological processes (primarily cancer of the stomach and intestines);
- diabetes mellitus;
- pituitary disorders;
Nutritional marasmus is distinguished from other diseases by a pronounced increase in thirst and appetite, hunger, very severe muscle exhaustion and skin changes, bradycardia and a decrease in body temperature, disruption of all endocrine glands.
Treatment for nutritional marasmus
Treatment of this disease at any stage begins with the normalization of the daily routine, nutrition, rest and sleep. Such patients are placed in a warm, ventilated ward, preventing contact with infectious patients. At the first stage of the disease, fractional nutrition with easily digestible food begins. In the second and third stages, nutrition is carried out both enterally (enpits are special nutrient mixtures) and parenterally by injecting glucose solutions and other nutrients intravenously.
The caloric content should be about 3000 kcal / day to begin with, gradually increasing to 4500 kcal / day. The diet must include animal proteins, the total amount of protein should be 2 g / kg / day. It is necessary to replenish not only nutrients, but also liquid by infusion of various solutions. At the third stage, blood transfusions (erythrocytes and plasma, albumin) are necessarily carried out. The acid-base state of the body is corrected. For the treatment of infectious complications, antibiotics are administered (according to sensitivity). Correction of the immune status, dysbiosis is also performed.
Prognosis and prevention
Usually, the disease without proper treatment leads to death within no more than 3-5 years. With timely treatment, the external effect can be achieved quickly enough, but the restoration of the function of internal organs can take years. Prevention is the promotion of a healthy lifestyle and proper nutrition.