TBL 2- Starvation

8/3/2019 TBL 2- Starvation

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Physiology of starvation

Definition

Causes of starvation

Effects of complete starvation


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Definition of starvation:

It is complete absence of food intake ,

except for water.


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1- Decreased availability of food as in famines

and poverty.


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2- Refusal of food intake either due to

psychological causes as anorexia nervosa orvoluntary starvation.


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3- Gastrointestinal causes as malabsorption

syndrome and cancer esophagus.


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Physiology of starvationEffects of complete starvation

1- Depletion of food stores in the body tissues.

0.1 Kg glycogen

0.4 Kg glycogen

12 Kg fat


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When fat stores are used up, tissue proteinsbecome the only

remaining source of energy and are rapidly catabolized.

During the first day of starvation, glycogen stores in the liver andmuscles are totally consumed

After glycogen depletion, fat & easily mobilizable proteins are used

for energy production. (gluconeogenesis, maintained blood glucose)

After all the easily mobilizable proteins are used, neutral fatbecomes

the only source of energy. (Ketosis, decreased blood glucose)

DEATH

50% tissue proteins


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1- Depletion of food stores in the body tissues.

Weeks of starvation

protein

fat

carbohydrate

Q

uantitiesoffoo

dstuffs(Kg)


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2- Vitamin deficiency

After a week, mild vitamin deficiencies usually begin

especially the water soluble vitamins (vit B and C)

After several weeks, severe deficiencies can occurwhich add to the debility leading to death.


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3- Gradual weight loss

The individual loses about 1 Kg/day for the first 10

days, then, 0.3 Kg /day afterwards.

Body organs also decrease in size ; the liver, the

kidneys, the heart and the gastrointestinal tract,except for thebrain ,which is spared.


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4- Decreased activity of both endocrine and exocrine

glands


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5- Decreased BMR and body temperature.


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6- Depressed cardiovascular functions

bradycardia,

decreased cardiac output,

lowered arterial blood pressure and postural

hypotension.


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7- CNS manifestations

Depressed mental functions

Increased sleeping hours.

Psychological disturbances


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8- GIT manifestations

Hunger pains occur but disappear after 2-3

days

Atrophy of the intestine and decreased

digestive secretions

Diarrhea.


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9- Blood changes

Blood glucose concentration is kept near the fastinglevel by gluconeogenesis

Decreased RBC count, hemoglobin content and

packed cell volume

Hypoproteinemia, which causes edema.

Starvation lipaemia due to fat mobilization.

Ketosis

Decreased alkali reserve as it is used to buffer the

ketoacids.


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The urine volume and specific gravity depend on the amount ofwater intake.

Ketinuria which lowers the pH of urine.

Decreased urea and uric acid excretion.

10- Urinary changes


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11- Edema

Due to:

hypoproteinemia.


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12- Death

usually occurs about 60 days from thestart of starvation.

The terminal event isintractable diarrhea.


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1. The starving person is given frequent small feeds ofskimmed milkor yogurt. Then, moderate amounts offats, vitamins and semisolid foods are gradually added.

2. In severely ill patients who refuse to eat, nasogastric orparentral feeding may be considered.


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QUESTIONSQUESTIONS


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11-- If a normal person is completelyIf a normal person is completely

deprived of food, the followingdeprived of food, the following

effects will resulteffects will result EXCEPTEXCEPT::

a)a) Ketosis andKetosis and ketonuriaketonuria

b)b) Increased secretion of epinephrine andIncreased secretion of epinephrine andnorepinephrinenorepinephrine

c)c) hypoproteinemiahypoproteinemia

d)d)vitamin deficiencies especially vitaminvitamin deficiencies especially vitaminB and C.B and C.


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22-- As starvation progresses all of theAs starvation progresses all of the

following is truefollowing is true EXCEPTEXCEPT::

a)a) Edema may occur.Edema may occur.

b)b) Signs of vitamins B and C deficiencySigns of vitamins B and C deficiencyappear.appear.

c)c) The amount of alkali reserve isThe amount of alkali reserve is

increased.increased.d)d)The hemoglobin content and packedThe hemoglobin content and packed

cell volume are decreasedcell volume are decreased


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deprived of food, glycogen stores willdeprived of food, glycogen stores will

be depleted afterbe depleted after

a)a) 1212 hourshours

b)b) One dayOne dayc)c) One weekOne week

d)d) One monthOne month


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44-- The most abundant amount ofThe most abundant amount of

glycogen is stored in the :glycogen is stored in the :

a)a) HeartHeart

b)b) LiverLiverc)c) Skeletal musclesSkeletal muscles

d)d) BrainBrain


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55-- AfterAfter 33 days of completedays of complete

starvation, blood sugar level isstarvation, blood sugar level is

maintained near fasting values by:maintained near fasting values by:

a)a) Catabolism of muscle and liver glycogenCatabolism of muscle and liver glycogen

into glu

cos

einto glu

cos

eb)b) Synthesis of glucose from easilySynthesis of glucose from easily

mobilizablamobilizabla proteins byproteins by gluconeogenesisgluconeogenesis

c)c) Oxidation of neutral fat stores in adiposeOxidation of neutral fat stores in adiposetissuetissue

d)d) Catabolism of tissue proteinsCatabolism of tissue proteins


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66--Tissue proteins areTissue proteins are catabolisedcatabolised andand

used as a source of energy only if:used as a source of energy only if:

a)a) All muscle glycogen is depletedAll muscle glycogen is depleted

b)b)All liver glycogen is depletedAll liver glycogen is depletedc)c) All easilyAll easily mobilizablemobilizable proteins andproteins and

neutral fat are depletedneutral fat are depleted

d)d) Blood glucose level is decreased.Blood glucose level is decreased.


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77-- During complete starvation,During complete starvation,

cardiovascular changes include thecardiovascular changes include the

following:following:

a)a) Postural hypotensionPostural hypotension

b)b) BradycardiaBradycardia..c)c) Decreased cardiac outputDecreased cardiac output

d)d)All of the aboveAll of the above


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deprived of food for one week, he willdeprived of food for one week, he will

suffer from:suffer from:

a)a) Severe constipation.Severe constipation.

b)b) Decreased sleeping hours.Decreased sleeping hours.c)c) Decreased basal metabolic rate.Decreased basal metabolic rate.

d)d)Weight loss by aboutWeight loss by about 00..11Kg/dayKg/day


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99-- During complete starvation forDuring complete starvation for

one week, the following change inone week, the following change in

the blood will result :the blood will result :

a)a) alkalosisalkalosis

b)b) Increased RBCs countIncreased RBCs countc)c) HyperproteinemiaHyperproteinemia

d)d) HyperlipidemiaHyperlipidemia


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1010-- The following conditions mayThe following conditions may

cause starvation EXCEPT:cause starvation EXCEPT:

a)a) FaminesFamines

b)b)Anorexia nervosa.Anorexia nervosa.c)c) MalabsorptionMalabsorption syndromesyndrome

d)d) Cancer colon.Cancer colon.


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Put true or false:Put true or false:

11-- during complete starvation, weight ofduring complete starvation, weight of

the brain tissu

e iskept relativelythe brain ti

ssue i

skept relativelyconstant.constant.


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22--The easilyThe easily mobilizablemobilizable proteins areproteins are

depleted veryslowlydepleted very

slowly


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33--The brain tissue cant utilizeThe brain tissue cant utilize ketoneketone

bodies

as

asource of energy.bodie

sas

asource of energy.


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44-- Hunger painsusually disappear afterHunger painsusually disappear after 22--33

days

ofstarvation.day

sof

starvation.


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55-- Severe diarrhea is a common cause ofSevere diarrhea is a common cause of

death in cases

of completestarvation.death in ca

ses

of completestarvation.


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66-- Duringstarvation, weight loss is initiallyDuringstarvation, weight loss is initiallyslow, then increa

ses

afterwards.

slow, then increa

ses

afterwards.


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DOAA SAMY

TBL 2- Starvation

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