What is Alimentary Marasmus (Alimentary Dystrophy)?
Alimentary insanity is a severe form of protein-energy deficiency with a predominance of energy deficiency.
At present, in a number of developing countries more than 500 million people are feeding incompletely in quantitative and qualitative terms. According to the UN, every third out of the total number of the dead dies from starvation or the causes associated with malnutrition.
Causes of Alimentary Marasmus (Alimentary Dystrophy)
Most often, alimentary marasmus occurs in infants and young children and occurs as a result of prolonged insufficient and qualitatively inadequate nutrition.
The main etiological factor of alimentary dystrophy is low calorie food. It is conditionally possible to accept that a decrease in the energy value of food by 40-50% against the initial normal caloric content leads to the development of the disease.
Pathogenesis During Alimentary Marasmus (Alimentary Dystrophy)
Full or partial protein starvation leads to the mobilization of protein in bones, muscles, skin, and to a much lesser extent – protein in internal organs.
Characterized by a sharp decrease in the protein content (up to 20-10 g / day) and the relative predominance of carbohydrates. At the same time, the content of ascorbic acid, vitamins B1, B2, B3, A, etc., is usually reduced in food.
With prolonged fasting, there is often an increased consumption of table salt (“saltiness”) and water, which in turn aggravates metabolic disturbances in the tissues and contributes to the development of edema.
In hot climates, insufficient caloric intake during considerable physical exertion also leads to the occurrence of group cases of nutritional dystrophy; joining intestinal infections forces this process. There are rare cases of neurogenic anorexia, in which the emaciation reaches the stage of cachexia.
Symptoms of Alimentary Marasmus (Alimentary Dystrophy)
Dry skin, loose skin folds hanging on the hips, under the arms, etc. Atrophy of the muscles and subcutaneous tissue, perhaps also alternating bands of pigmented and depigmented hair, spots on the skin caused by its peeling. The patient is often irritated and insatiable hungry.
According to the accepted classification, two forms are distinguished:
- dry, or cachectic form, less favorable in prediction, and
- edematous form, within which edematous-ascitic (ascitic) variant is isolated with the most unfavorable prognosis.
By severity allocate 3 stages of the disease. Stage I includes cases in which severely emaciated people still retain some ability to work; they complain of weakness, chilliness, frequent urination, increased appetite and thirst; they usually have moderate hypoproteinemia due to a reduction in serum albumin. A sharp emaciation, loss of working capacity, but still remaining the opportunity to move, to serve themselves are characteristic of stage II of alimentary dystrophy. Often, these patients develop peripheral edema, a further decrease in serum albumin is observed, and hypoglycemia is frequent. At stage III of severity, the patient is dramatically exhausted, often unable to sit on his own in bed, lying, usually motionless and indifferent, on his side with legs bent at the knees. The appearance of a hungry coma (even if it developed in a patient who continued to work) should indicate the presence of stage III disease.
Diagnosis of Alimentary Marasmus (Alimentary Dystrophy)
Diagnosis of alimentary dystrophy usually does not cause difficulties and is based on the presence of appropriate symptoms, anamnestic indications of starvation, exclusion of the disease causing exhaustion. Differentiate primarily from cancer of the stomach and intestines, tuberculosis and endocrine diseases (diabetes, thyrotoxicosis, pituitary cachexia). It should be noted that a sharp increase in appetite (bulimia), thirst, a special “hungry psychology” markedly distinguish patients with alimentary dystrophy from those with cachexia, which developed as a result of the diseases listed above. With cancer and tuberculosis, there is no such severe muscular atrophy as with alimentary dystrophy. Inherent symptoms of endocrine diseases significantly distinguishes each of these diseases from alimentary dystrophy.
Treatment of Alimentary Marasmus (Alimentary Dystrophy)
In the treatment of nutritional dystrophy, good hygiene conditions, proper treatment and care are important. Patients should be placed in spacious, bright and warm wards. Maintaining the temperature in the wards within 21-23 ° C is important because patients have a chilliness. Patients with pneumonia, diarrhea syndrome must be isolated from the rest because of their sensitivity to infection. Bed rest (at least 5-7 days) is prescribed to patients with alimentary dystrophy II and III stages. Patients with alimentary dystrophy stage II in the first days are allowed only minor exercise (sit in bed, slowly get up in the presence of medical personnel, etc.) due to the risk of developing a hungry syncope and even coma. Patients are provided not only physical, but also mental peace; observation of them is carried out taking into account changes in their mental state.
Patients receive fractional, mechanically gentle nutrition at least 6-7 times a day. Daily caloric in the first 7-10 days 2500-3500 kcal. In the daily diet of at least 100-120 g of protein, 70-80 g of fat, up to 500 g of carbohydrates. In the future, the caloric content of food increases (3500-4000-4500 kcal). There are proposals to conduct cycles of enhanced nutrition with an increase in the protein content up to 130-150 g.
Patients with the edematous form of alimentary dystrophy limit the consumption of salt to 5 g / day and water to 1, 5 l. Food should be well fortified; patients receive per day at least 100 mg of ascorbic acid, up to 10,000 IU of vitamin A, at least 10 mg of vitamin B1, 50-100 mg of nicotinic acid. To improve digestion, hydrochloric acid, pepsin, pancreatin (and similar enzyme preparations) are prescribed.
Currently used enteral nutrition and artificial preparations for enteral nutrition – enpits. In severe cases (stage III), parenteral nutrition methods are used (various protein hydrolysates, amino acid preparations, fat emulsions, etc.).
From the 2-3rd week for the purpose of rehabilitation, taking into account the individual features, physical methods of treatment and physical therapy are prescribed.
Treatment of hungry coma. This severe and prognostically extremely dangerous condition requires emergency intensive care. 50 ml of 40% glucose solution should be injected into a vein immediately and then these injections should be repeated every 2-3 hours. This measure is most effective. It can be assumed that positive results are obtained by intravenous drip of isotonic glucose or reopolyglucine with 1-2 ml of 0.2% norepinephrine solution and 125 mg of hydrocortisone. Parenteral preparations of caffeine, strychnine, cordiamine are also prescribed. For convulsions, calcium preparations are used (10 ml of a 10% solution of calcium chloride in a vein or 10 ml of a 10% solution of calcium gluconate in a muscle).