Disease Information for Starvation recovery/edema syndrome

Recovery Treatment of Starvation: The treatment of severe protein-energy malnutrition is a slow process requiring great care; Initial efforts should be directed at correcting fluid and electrolyte abnormalities and infections; Of particular concern are depletion of potassium, magnesium, and calcium and acid-base abnormalities; The second phase of treatment is directed at repletion of protein, energy, and micronutrients; Treatment is started with modest quantities of protein and calories calculated according to the patient"s actual body weight; Adult patients are given 1 g of protein and 30 kcal/kg; Concomitant administration of vitamins and minerals is obligatory; Either the enteral or parenteral route can be used, although the former is preferable; Enteral fat and lactose are withheld initially; Patients with less severe protein-calorie undernutrition can be given calories and protein simultaneously with the correction of fluid and electrolyte abnormalities; Similar quantities of protein and calories are recommended for initial treatmen; Patients treated for protein-energy malnutrition require close follow-upPatients who are refed too rapidly may develop a number of untoward clinical sequelae: During refeeding, circulating potassium, magnesium, phosphorus, and glucose move intracellularly and can result in low serum levels of each; The administration of water and sodium with carbohydrate refeeding can overload hearts with depressed cardiac function and result in congestive heart failure; Enteral refeeding can lead to malabsorption and diarrhea due to abnormalities in the gastrointestinal tract; Refeeding edema is a benign condition to be differentiated from congestive heart failure; Changes in renal sodium reabsorption and poor skin and blood vessel integrity result in the development of dependent edema without other signs of heart disease; Treatment includes reassurance, elevation of the dependent area, and modest sodium restriction; Diuretics are usually ineffective, may aggravate electrolyte deficiencies, and should not be used;The prevention and early detection of protein-energy malnutrition in hospitalized patients require awareness of its risk factors and early symptoms and signs; Patients at risk require formal assessment of nutritional status and close observation of dietary intake, body weight, and nutritional requirements during the hospital stay. [CMDXRX2005].

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