Treatment Of Malnutrition And Starvation

Starvation may conveniently be defined as malnutrition of sufficient severity to warrant in-patient treatment in hospital; the body weight is reduced to less than 75% of normal.

Causes:

Malnutrition and starvation arise

• When there is not enough food to eat, for instance in times of famine.
• When there is severe disease of the digestive tract, preventing the absorption of nutrients, as in the malabsorption syndrome and cancer of the esophagus
• When there is a condition which prevents normal metabolism of nutrients by the tissues, e.g. in renal or hepatic failure or protracted infections. In all these circumstances there is wasting of the body with much loss of both muscle and fat.

Treatment of malnutrition and starvation is listed below.

• In mild malnutrition, all that is needed is suitable food. Management is more an administrative than a medical problem. When the patient is seriously ill, treatment must depend on the facilities available.
• Most famine victims, because of alimentary dysfunction, cannot deal with large quantities of food. The patient's appetite may be immense and no guide to digestive capacities. Limitation of the food intake is essential if there is diarrhea or a severe degree of cachexia.
• The choice of food needs care. In advanced cases only bland food can be tolerated by the thin-walled intestines lacking essential digestive enzymes. Skimmed milk may not be well tolerated if the patient has deficient intestinal lactase activity. It is advisable to give foods with which the patient is familiar.
• The ideal diet to start with is one based on the patient's staple cereal and some sucrose or glucose together with moderate amounts of bland, protein-rich food, e.g. milk powder, and some fat or oil.
• Small feeds should be given at frequent intervals and new foods added one at a time to see that they do not increase diarrhea. It is advisable to give a multivitamin preparation. With refeeding there may be some increase in edema, unless the supply of salt is restricted.
• There may come a time when a patient with severe starvation refuses all food, although fully rational. Feeding of milk and other fluids through a nasogastric tube then provides the only hope.
• Physical and psychological recovery is usually complete if sufficient calories are provided for cases of primary malnutrition. When irreversible changes have developed in the heart and small intestine in severe starvation, the prognosis is poor.
• Prevention rests with legislators and administrators. Famines from crop failure can be greatly alleviated by advanced contingency planning. Those caused by a natural disaster like an earthquake are unexpected: the outcome depends on how well the country's administration stands up to the strain. Famines resulting from war are the most difficult.