1. investigation
• Plasma free fatty acid increased
• Ketosis
• Mild metabolic acidosis
• Plasma glucose is low but albumin concentration is maintained
because of normal liver function
• Insulin secretion decreased
• Glucagon and cortisol increase
• Reverse T3 replaces normal triiodothyronine
• Resting metabolic rate falls because of falling lean body mass or
hypothalamic compensation
2. • Urine has fixed specific gravity and creatinine excretion become low
• Mild pancytopenia
• ESR is normal unless there is infection
• Tests of delayed skin hypersensitivity eg to tuberculin , become falsely
negative
• ECG shows sinus bradycardia and low voltage
3. Management:
• Starvation kills but usually slowly; an average man or woman has enough
body fat to live on for 40 days , provided fluids are still consumed but ill
guided attempt at treating undernutrition can rapidly kill an otherwise
healthy patient
• Patient with mild starvation are not in great danger
• With moderate starvation need extra feeding
• With severe starvation need hospital care , particularly to avoid death from
refeeding syndrome
• Correct fluid and electrolytes first and their careful monitoring for atleast 7
days of refeeding as there is often marked depletion of potassium,
phosphate and magnesium after starvation
4. • If insulin is stimulated by food without correcting these , their sudden
movement into cells cause sudden arrhythmic death
• Give thiamine to correct deficiency before food is administered to
avoid precipitating beri beri
• When food is available then can be given but in small frequent diet
• During refeeding weight gain of 5% body weight per month indicate
satisfactory results
• Supportive care indicates attention to skin , adequate nutrition ,
treatment of infection and careful monitoring of body temperature
