Cachexia

The degree of complete exhaustion of the human body is designated by the medical term cachexia. This is a condition when the patient's body rapidly loses weight, vitality decreases to the extreme limits, all physiological processes slow down, and changes occur at the mental level.

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Causes of cachexia

This disease changes the patient beyond recognition. Images from documentaries about World War II, concerning concentration camps, come to mind. In modern life, the causes of cachexia are determined by a wide range of factors.

• Diseases of the esophagus (stenosis), which make it difficult for food to enter the patient's stomach.
• Fasting for a long period of time.
• Severe form of heart failure.
• Chronic forms of brucellosis and tuberculosis, in which the patient's body is subjected to prolonged intoxication.
• Nodular polyarthritis.
• Purulent processes in the body (progressive osteomyelitis and abscesses, suppurating bronchiectasis).
• Cancerous tumors.
• Diseases of the gastrointestinal tract, the consequences of which are a failure of the functions of digestion of food and absorption of its mucous membrane (gastrectomy, enterocolitis, consequences of gastric resection (celiac disease), etc.).
• Amyloidosis.
• Disruption of the endocrine system, metabolic disorders (pathology of the adrenal glands and thyroid gland).
• Psychogenic anorexia.
• Long-term use of psychostimulants.
• Malnutrition.
• Diffuse connective tissue diseases.
• Hypotrophy in young patients.
• Acquired immune deficiency syndrome (AIDS).

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Symptoms of cachexia

The course of the disease, the predicted outcome, and, accordingly, the symptoms of cachexia largely depend on the nature of the disease that caused it. But the main symptoms are as follows:

• Rapid weight loss (severe cachexia indicates a loss of half a person's normal weight).
• Loss of ability to work.
• Decreased overall vitality.
• A dangerous loss of fluid by the body and its accumulation in the serous cavities of the body is a consequence of a failure of blood circulation and lymph flow (transudate).
• Loss of fat cells.
• General weakness.
• Avitaminosis.
• Protein-free edema.
• The skin is flabby, wrinkled, and the color is unnaturally pale, gray-green.
• Increased brittleness of hair and nails.
• Stomatitis.
• Dysbacteriosis.
• Constipation.
• Loss of teeth.
• Decreased immunity.
• Amenorrhea in women (absence of menstruation for several menstrual cycles).
• Deterioration of potency in men.
• Malfunction of intestinal peristalsis.
• Blood pressure is low.
• Constant feeling of cold.
• Decreased glomerular filtration in the kidneys.
• Decreased circulating blood volume.

Frequent mental disorders:

• Asthenia.
• Subdepressive mood.
• Tearfulness.
• Clouding of consciousness.
• Apathetic stupor.
• Less common is psycho-organic syndrome.

Degrees of cachexia

Doctors distinguish three degrees of cachexia:

Hypothalamic form of the disease. It is characterized by a complete or partial cessation of peptide synthesis in human plasma. The consequences of such a failure:

• Inhibition of the production of protein kinases (phosphotransferases) involved in the modification of many proteins.
• Blocking the process of lipogenesis, which includes the breakdown, digestion and absorption of lipids in the digestive tract, the transport of fats from the intestines, and the metabolic transformation of triacylglycerols, cholesterols and phospholipids.
• Decreased activity of endothelial lipoprotein lipase (regulates blood lipid levels, which is important in atherosclerosis).
• Anabolism (metabolic processes) is suppressed.
• Fat transport slows down.
• Intensification of catabolism (energy metabolism) occurs.

Cachechtin form of the disease. Accompanied by increased production of cachechtin, as a result of which the following is observed:

• Frequent and prolonged emotional breakdowns.
• Loss of appetite.
• Imbalance in the synthesis of neuropeptides (protein molecules formed in the central or peripheral nervous system and regulating the physiological functions of the human body).
• Rapid development of anorexia (pathological weight loss).

Anorexic form of the disease. It is represented by malabsorption (impaired absorption of substances in the small intestine):

• An increase in the number of new formations, such as necrotic alpha tumors, in the blood plasma.
• Deficiency of thymus hormones.
• Hypocorticism (pathological changes caused by hypofunction of the adrenal cortex).
• Hypoinsulinism (an endocrine disease characterized by episodes of significant decrease in blood sugar levels).

All this leads to rapid loss of human body weight.

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Classification of cachexia

Depending on the etiology of the disease, cachexia is classified in several directions:

Exhaustion of the body associated with exogenous factors (influence of the surrounding, external environment):

• Lack of nutrition.
• Fasting (of a religious nature or a manic desire to lose weight).

Endogenous causes (internal failures):

• Chronic stage of radiation sickness.
• Disruption of the adrenal glands.
• Senile involution of the organism.
• Presence of a malignant tumor.
• Disruption of the endocrine glands.
• Myxedema (insufficient supply of thyroid hormones to the body's organs and tissues).
• Consequences of trauma.
• Terminal (dystrophic) form of chronic heart failure.
• Postoperative hypothyroidism (long-term, persistent deficiency of thyroid hormones).
• Significant reduction in mental activity.

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Pituitary cachexia

Violation of the integrity of the functioning of the anterior pituitary gland and hypothalamic centers, manifested in insufficient production or complete absence of production of triple hormones of the adenohypophysis, leads to the appearance of hypocorticism (dysfunction of the adrenal glands), hypothyroidism (decreased thyroid function) and hypogonadism (reduction in the amount of produced male sex hormones - androgens). All these failures lead to the fact that pituitary cachexia develops in the patient's body.

The cause of such pathology may be:

• Injury.
• An inflammatory process occurring in the pituitary gland.
• Malignant or benign tumor.
• Bleeding and collapse during childbirth with subsequent ischemia or thrombosis of vessels in the hypothalamic-pituitary system.
• Spasm and thrombosis of the arteries supplying blood to the anterior lobe and stalk of the pituitary gland cause necrosis of the adenohypophysis.

Cerebral cachexia

Cerebral cachexia is diagnosed with pathological changes in the hypothalamus. Often, the disease affects not only the pituitary gland, but also inflammatory, dystrophic processes affect the diencephalon. When such pathology dominates over the pituitary gland, and there is a sharp loss of weight, doctors diagnose the cerebral form of the disease.

There are known cases of sudden weight loss, while the studies conducted did not reveal any abnormalities in the endocrine system. Often, such patients have a history of psychological trauma (shock, fright). Anorexia of this nature is quite common and leads to the development and progression of the cerebral form of the disease. It is very difficult to treat a disease of this etiology, since medicine has not fully studied all the processes occurring in the brain.

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Alimentary cachexia

If the cause of anorexia is prolonged malnutrition, poor nutrition, voluntary or forced starvation, and general exhaustion of the body develops, doctors classify this pathology as alimentary cachexia.

With such a pathology, there is a failure in all metabolic processes of the body, dystrophy of organs and tissues progresses, disrupting their functioning. A person's physical activity decreases, changes in the psychological perception of the surrounding society appear.

The alimentary form of the disease acquires a mass social status during periods of natural disasters (loss of food during floods and earthquakes...) and social conflicts (war, artificial famine).

During a period of prolonged malnutrition, the body does not receive the necessary nutrients, vitamins and microelements for normal functioning, which are a source of energy. This leads to a reduction in energy costs, loss of psychological, intellectual and physical ability to work. There is a redistribution of essential substances, which contributes to a mismatch in the work and trophism of various systems and organs. The hormonal background is subject to restructuring (failure of the thyroid gland, glands of the reproductive system, adrenal glands). Limiting protein foods provokes hypoproteinemia, which is manifested by protein edema.

Gradually, atrophy of the muscles of the skeletal frame occurs, the patient loses subcutaneous tissue. When conducting studies of such patients, a decrease in the size of the liver by 2 - 2.5 times is revealed, and other organs also atrophy.

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Malignant cachexia

Malignant cachexia most often occurs in patients suffering from rapid decomposition of the tumor conglomerate, while the size of the tumor does not matter.

Causes of exhaustion:

• Intoxication of the body with toxins from cancer cells or “waste products” of associated complications.
• Accumulation of excess lactic acid, which has a detrimental effect on the condition and functioning of the liver. The patient's body counteracts it by breaking down sugar in the blood, mobilizing its carbon reserves. It cannot replenish the losses.

Most often, the malignant form of the disease is a companion of cancerous neoplasms of the gastrointestinal tract, respiratory tract. As a result of diseases of the digestive system, there is an aversion to many food products. As a result, the body does not receive many nutrients necessary for normal life.

However, there are frequent cases (for example, scirrhus - a type of stomach cancer - a sharply deforming organ, disrupting its motility and secretory work), when cachexia does not occur. While small tumors can provoke its rapid progression. Therefore, it is impossible to clearly identify the cause of the pathological deviation today.

Cardiac cachexia

As a result of the lack of nutrients, the myocardium is also exposed to pathological effects. The heart gradually loses its pumping ability to pump blood in the volume necessary for the normal functioning of the body. Defects and ischemic heart disease lead to a similar result. As a result, a person develops heart failure. In severe forms of chronic heart failure, significant weight loss is observed. This pathology is classified as cardiac cachexia.

The mechanism of the appearance and development of cachexia is not completely clear, but it is definitely composed of multiple factors. The main ones for the cardiac form of the disease are:

• Hepatomegaly, which is caused by blood stagnation in the venous system.
• A persistent feeling of fullness in the stomach.
• Increased levels of inflammatory cytokines.
• Violation of intestinal peristalsis.

It is very difficult to diagnose cachexia of this etiology, but the prognosis for recovery is quite favorable.

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Senile cachexia

A person ages because his body ages. Metabolic processes slow down, skin regeneration slows down, and so on, but severe exhaustion of an old person's body cannot be considered normal. Often after 50 years, there is a significant reduction in muscle mass, while the amount of fat increases. These are the consequences of a sedentary lifestyle, sedentary work, and dietary restrictions.

The body ages, various diseases appear, which can cause severe exhaustion of the body, which falls under the category of senile cachexia.

Treatment of cachexia

Severe exhaustion is already a consequence of external factors or some diseases affecting the body. Therefore, the treatment of cachexia comes down to eliminating, first of all, the causes that caused progressive weight loss. If exhaustion is a consequence of a disease, then the patient must undergo a full course of treatment. If cachexia was provoked by external factors, it is necessary, accordingly, to reduce their impact to a minimum and undergo restorative therapy.

But a mandatory point in normalizing the patient's condition is the systematic restoration of a balanced diet, careful care for it. Easily digestible proteins, vitamins, fats, and products rich in microelements are necessarily introduced into the diet. If the patient shows symptoms of a malfunction of the digestive tract and absorption system, the doctor prescribes polyenzyme medications, such as pancreatin.

• Pancreatin

The amount of the prescribed medicine depends on the patient's age and the degree of deficiency of enzymes produced by the pancreas. The drug is taken before meals or with food, washed down with a large volume of water or, preferably, an alkaline liquid (fruit juice).

The average daily dosage of the drug, divided into three to six doses, is 0.25 - 0.5 grams. In case of complete insufficiency of the secretory function, the dosage is increased to 0.75 grams per day. For children under one and a half years of age, the starting dose is 0.1 grams, for older children - 0.2 grams.

The duration of the treatment course depends on the severity of the disease and varies from several days to months and years.

Contraindications to the medicinal product include:

• Individual intolerance to one or more components included in the drug.
• Acute or chronic pancreatitis in the acute stage.

When taking the medicine, the following side effects may occur:

• Inflammation of the pancreas.
• Allergic reactions.
• With prolonged use – hyperuricosuria (urine analysis shows an increased amount of lactic acid).

If the patient is in a serious condition, glucose, amino acid mixtures, vitamins, and protein hydrolysates are administered parenterally (bypassing the intestines - intramuscular or intravenous injections). If necessary, the doctor adds anabolic steroids (for example, andriol).

In case of psychogenic cachexia, a psychiatrist and neurologist give their prescriptions (for example, drugs that increase appetite: periactin, primobolan-depot).

• Glucose

The medicine is administered orally, intravenously, and by intramuscular injection. The dosage for one dose is 0.5 - 1 gram.

Glucose is administered subcutaneously or intravenously as a 4.5-5% solution in the amount of 300-350 ml. In the form of enemas - up to two liters per day.

With a large volume of the drug administered, a water-salt imbalance, increased fluid, and thrombosis may occur in the patient’s body.

The only contraindication for the use of glucose may be diabetes mellitus in the patient.

• Andriol

The required dose is prescribed by the attending physician strictly individually, depending on the clinical picture. The recommended initial daily amount is 120-160 mg for two to three weeks, with a subsequent reduction in dosage to 40-120 mg daily. The capsule of the drug is taken after meals, if necessary, with a small amount of liquid. Do not chew or open the capsule, swallow it whole. The daily dosage is divided into two doses: morning and evening. If the daily amount is an odd number of capsules, a larger dosage is taken in the morning.

The drug is contraindicated for use by patients with a history of verified prostate or breast carcinoma.

• Periactin

The medicine is prescribed by the doctor to increase the patient's appetite. The adult dosage is:

• tablets – 0.5 – 1 piece three to four times a day.
• syrup – one to two teaspoons three to four times a day.

For children aged two to six years, the maximum daily dose is two tablets or two tablespoons of syrup.

For children aged 6 to 14 years, the maximum daily dose of the medicine is three tablets or three tablespoons of syrup.

The drug is contraindicated in cases of increased intraocular pressure, asthma, stomach ulcers, and in the elderly.

• Primobolan Depot

The drug is administered intramuscularly:

• Adults: one ampoule every two weeks, then 1 ampoule every three weeks.
• For children, the dosage is administered at a rate of 1 mg per kilogram of the baby’s weight once every two weeks.

The drug is contraindicated for men suffering from prostate cancer and pregnant women.

Nutrition for cachexia

A diagnosis of exhaustion is given to a person if his weight deviates significantly downward from the norm. Just as for obese people there is a problem of losing weight, so for very thin people there is a real problem of gaining weight and bringing it to the norm. In addition to medical means, nutrition in cachexia can also normalize the patient's weight.

Such patients often have no appetite, and feeding them is quite problematic. Therefore, it is worth starting with small but high-calorie portions. The body must gradually "get used" to food. The maximum effect is achieved if the meal is divided into five to six approaches and is subject to a schedule. Eating at the same time stimulates the patient's digestive system. Meals should be tasty and aesthetically attractive - this is another incentive to stimulate appetite. Forcing a person to eat through force - can achieve the opposite result.

Food should be varied, balanced, stimulating the desire to eat more. Nutritionists advise:

• First courses made with rich broth or strong decoction with a dressing of sour cream, cream or yolks.
• Smoked fish.
• Pepper sauces.
• Spices.
• Freshly squeezed fruit and vegetable juices.
• Desserts.

If there are no medical contraindications, then you can eat all the products. You should just remember that they should be high-calorie. It is also necessary to prepare dishes using vegetable and butter oils, cream. The diet of such a patient must include:

• Pastries.
• Drinks containing large amounts of fat.
• High-calorie desserts.

Pieces of meat and fish are best baked with vegetables or fried in vegetable oil. Fatty meats go well with sour and spicy sauces and seasonings (hot sauce, horseradish, adjika, lemon, mustard).

Salads consumed by the patient should contain:

• Boiled vegetables with butter.
• Fried and stewed vegetables.
• The ideal seasoning is mayonnaise.

In this case, the following would be suitable as a side dish:

• Porridges made from cereals seasoned with butter.
• Pasta.
• Boiled potatoes with butter.
• French fries.
• Potatoes - mashed with milk, cream or sour cream.
• Potatoes baked with fat.

Dessert can be taken not only at lunchtime, but also with other meals:

• Casseroles made from cottage cheese, pasta and porridge.
• Pies and kulebyakas.
• Puddings.
• Desserts can be not only sweet, but also salty.

Nutritionists advise avoiding monotony.

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Prognosis for cachexia

Any prognosis depends on the nature of the disease, the severity of its course. The prognosis for cachexia directly depends on the factors and the disease that provoked it. Cachexia provoked by a cancerous tumor indicates an advanced late stage of the disease and gives an unfavorable prognosis for recovery. If severe exhaustion is caused by other reasons, then such a patient has a chance to recover, but on condition that adequate effective treatment is carried out, with adherence to the diet and correction of the patient's lifestyle.

In nature, everything is harmonious and deviations, both towards excess weight and its sudden loss, lead to serious illnesses, the end of which can be fatal.

Cachexia is not a death sentence (excluding oncological diseases) and it can be fought, but it should be done only under the constant supervision of a certified specialist. Amateur action in this case is inappropriate, since your life is at stake!

ICD-10 code

According to the International Medical Classification ICD 10, cachexia belongs to class XVIII of diseases. To the category R50 – R69 of general symptoms and signs. In sick leave, cachexia is coded as R64.

Read also:

• Cancer cachexia