Starvation’s Grip The Alarming Health Consequences You Need to Know

DEFINITION

Starvation may be defined as the actual withholding of food and drink or the administration of unsuitable food.

TYPES OF STARVATION-

A. Acute Starvation

B. Chronic Starvation

CAUSES OF STARVATION–

1. Acute-

a) Trapped in pits mines landsides

b) Willful withholding of food

c) Willful refusal to take food.

d) Captivation

e) Natural calamities

2. Chronic –  

a) Famine and famine-like condition

b) Neglect by parents, guardians, or caregivers

c) Diseases

d) Psychological- Eating disorder

MEDICOLEGAL CLASSIFICATION

SUICIDAL:-

• Lunatics
• Hysterical
• Hunger strike

HOMICIDAL:-

• Infant (unwanted or illegitimate)
• Dependant old people

ACCIDENTAL:-

• Trapped in pits, mines, landslides, shipwrecks, masonry falling, islands, etc

NATURAL:-

• Stricture or ca-esophagus
• Ca-Larynx, Lymphoma, Ca-Lung, Oral cancer, etc
• Psychological- schizophrenia, dementia, the delusion of poverty, etc

SYMPTOMS AND SIGNS OF ACUTE STARVATION

GENERAL FEATURES-

1. Feeling of hunger for the first 30-48 hrs.
2. Pain in the epigastrium is relieved by pressure.
3. General emaciation and the absorption of subcutaneous fats begin after 4-5 days. More than 35% of body weight loss is life-threatening, and more than 35% is fatal.
4. The skin luster is lost with loss of elasticity.
5. Mental condition– Irritable, confusion, loss of judgment
6. Voice– Weak, husky and lastly whispering
7. Temperature– subnormal
8. Pulse– bradycardia at rest, but paroxysmal tachycardia on exertion.
9. Respiration– Labored, shallow, and rapid.

      SPECIFIC FEATURES

1. Face– Cheeks are sink, and bony prominence becomes visible
2. Eyes – Eyes are sunken, and glistening pupils are dilated.
3. Hair– Dry, brittle, lusterless
4. Lips–  Dry and cracked.
5. Oral cavity–
   1. Tongue coated
   2. Offensive odor at breath
   3. Saliva- scanty
   4. Ulceration of tongue, lips, mouth cavity
6. Chest–
   1. The ribs of the chest are prominent.
   2. Intercostal muscles are depressed.
   3. Sunken supraclavicular fossae
7. The abdomen seems sunken and may be scaphoid-shaped.
8. Urine– Scanty, high colored, with dysuria
9. Stool– Hard stool with constipation in early, lately diarrhea and dysentery

FATAL PERIOD

• Both water and food complete withdrawal death occurs in 10-12 days. If food alone is withdrawn, death occurs in 6-8 weeks or even more.
• Death occurs when about 70-90% of body fat and 20% of body protein are lost.
• A newborn may survive for 7-10 days without water and food.

FACTORS INFLUENCING THE FATAL PERIOD

1. Age

2. Sex – Females may have endured starvation for longer.

3. Build- fatty, healthy people stand better.

5. Types and rate of food supply

4. Temperature.

5. Physical exertion- active physical exertion hastens death

6. Hormone & enzymatic status

7. Presence of other systemic disease

CHRONIC STARVATION

SYMPTOMS & SIGNS

1. Appearance– Extremely emaciated. Limbs are thin and weak. Irritated or in the stage of stupor
2. Face– Cheeks are sink, and bony prominence becomes visible
3. Eyes – Eyes are sunken, and glistening pupils are dilated.
4. Hair– Dry, brittle, lusterless
5. Skin-luster is lost with the loss of elasticity
6. Lips– Dry and cracked.
7. Oral cavity–
   1. Tongue coated
   2. Offensive odor at breath
   3. Saliva- scanty
   4. Ulceration of tongue, lips, mouth cavity
8. Chest–
   1. The ribs of the chest are prominent.
   2. Intercostal muscles are depressed.
   3. Sunken supraclavicular fossae

8) Abdomen–  seems sunken, may

scaphoid shaped

TREATMENT OF STARVATION-

• Removal  from the source
• Correction of fluid and electrolytes
• Solid food should be avoided first, starting with liquid food with food supplementation and skimmed food
• If severe vomiting, i/v (carbohydrate, protein & fat)
• Add vitamins and mineral
• Antibiotics to cure infection and to prevent secondary infections
• Antifungal cream and drugs should be given as necessary
• Rehabilitation

POSTMORTEM FINDING

EXTERNAL

1. Generalized loss of subcutaneous fat all over the body.
2. Eyes are sunken.
3. Malar bones are prominent.
4. Checks are sunken.
5. Bony prominence is prominent.
6. The ribs of the chest are prominent.
7. Intercostal muscles are depressed.
8. The abdomen seems sunken and scaphoid-shaped.
9. The skin luster is lost with loss of elasticity.

 INTERNAL

1. The heart is small with brown atrophy
2. The lungs are pale and collapsed and show little blood when cut
3. The stomach and intestines show atrophy of all coats and are stained with bile
4. Intestines become Bloating, paper-like, and thin in appearance
5. The gall bladder is distended with thick, inspissated bile
6. The liver, spleen, and kidneys are atrophied and show fatty degeneration
7. Signs of intercurrent infections may be found