What is cardiac cachexia? Cachexia symptoms, treatment, description. Cachexia: symptoms and treatment

What is this disease - cachexia? Many patients who have been diagnosed with this disease are interested in information about it. Doctors say that the disease is characterized by complete depletion of the body for various reasons. Such a condition is accompanied not only by weight loss, but also by metabolic disorders, impaired immunity, and changes in the psyche. This disease requires urgent hospitalization and conservative therapy. The prognosis is often unfavorable.

What is this disease?

Cachexia (according to ICD-10 code - R64) is a severe depletion of the body. The disease can be associated with many disorders of the internal organs, and sometimes develops through the fault of the person himself, who seeks to lose weight and get rid of extra pounds.

Cachexia (ICD includes it in the class of symptoms, signs and abnormalities) may be associated with disorders such as:

• diseases of the nervous system;
• tumors;
• endocrine disorders;
• drastic weight loss.

Despite the various causes of the problem, its manifestations are almost always the same. As weight decreases, a deficiency of nutrients occurs, as a result of which metabolic processes are disturbed, internal organs suffer.

The peculiarity of the course of the disease and its outcome is largely influenced by the age of the patient and the cause that provoked disorders in the body.

Causes

Cachexia (ICD-10 code above) refers to the catastrophic depletion of the body, which causes internal organs to suffer. The disease can be primary and secondary. Primary cachexia refers to the depletion that occurs on the background of a strict diet, when an insufficient amount of nutrients enters the body.

Such data are not reflected in the ICD, but cachexia of the secondary type can be caused by:

• pathologies of the stomach and intestines;
• infectious diseases;
• cancerous tumors;
• psychological disorders;
• taking certain medicines;
• endocrine disorders.

Malignant neoplasms play a special role in the occurrence of cachexia. The disease is characterized by the fact that during its course metabolic processes of the body are disturbed, and poisoning with toxic substances produced by the tumor also occurs. Infectious processes lead to intoxication, as a result of which a person begins to lose weight dramatically.

Symptoms

It is important to know what it is - cachexia, how exactly such a violation manifests itself in the body. The disease is characterized by symptoms such as:

• rapid and severe weight loss;
• muscle weakness;
• dehydration;
• deterioration of the immune system;
• sleep disorder;
• pressure reduction;
• mental problems.

When cachexia occurs, as a result of an insufficient amount of nutrients, the skin loses its former elasticity. The skin becomes sluggish and becomes earthy or very pale. Violation of tissue nutrition leads to severe brittle nails, the development of stomatitis and hair loss.

Cachexia can also be accompanied by disruption of the genitourinary system, intestines and stomach. In patients, sexual desire is sharply reduced and completely disappears. There are mental disorders, there is a strong irritability, lethargy, apathy, tearfulness, severe weakness.

Classification

It is important to know not only what it is - cachexia, but also what types of this disease are, so that it is possible to recognize the violations occurring in the body in a timely manner. In clinical practice, several forms of the course of the disease are distinguished, each of which differs in the mechanisms of development. In particular:

• hypothalamic;
• cachechtinic;
• anorexic.

In addition, the disease can be divided into several types, depending on the cause that provoked exhaustion. Particular attention should be paid to the following types:

• alimentary;
• pituitary;
• malignant;
• senile;
• cerebral;
• cardiac.

The pituitary and cerebral type affects the brain and develops as a result of a violation of its functioning. They are quite difficult to treat, there is a high risk of death. Alimentary cachexia occurs due to malnutrition.

The cardiac form is characterized by the fact that there is a decrease in the ability of the heart muscle to maintain normal blood circulation.

Cancer type of cachexia

Cancer cachexia usually occurs as a result of the course of severe stages of the development of a malignant neoplasm of the digestive system, lungs, brain and breast. Depletion is due to the fact that the tumor absorbs nutrients, and toxic substances that poison the human body are released into the bloodstream. With the progression of intoxication processes, there is a decrease in appetite, up to a complete refusal of food and nausea.

It is important to carry out aggressive therapy, since during chemotherapy, the decay of the tumor provokes a metabolic disorder in the body. A special group includes patients with cancer cachexia, which was provoked by the presence of a neoplasm in the area of ​​the digestive organs, the oral cavity, which makes food intake impossible.

With the progression of this disease, irreversible changes occur in the body, and as a result, the death of the patient. Cachexia in oncological diseases is treated only symptomatically. A person should adhere to a dietary diet enriched with vitamins with the inclusion of easily digestible, but high-calorie foods. If cachexia in oncological diseases is difficult, with severe nausea and vomiting, then antiemetic drugs are prescribed. Slowing down the process of weight loss contributes to the intake of fish oil.

Alimentary cachexia

Many are interested in what it is - alimentary type cachexia, how this disease manifests itself. The pathological process occurs when the need for nutrients is not met by the food consumed. This may be due to the observance of strict diets, pathological processes of the digestive system, the presence of a tumor. As a result, patients experience an aversion to food, nausea, and difficulties arise with food consumption as a result of damage to the oral cavity.

As weight loss further joins the psychogenic factor, the woman ceases to adequately assess her condition, continues to refuse food, even when the usual way of life becomes impossible.

Pituitary cachexia

People who are diagnosed with a brain tumor are interested in what it is - pituitary-type cachexia. A similar condition is diagnosed during pathological processes occurring in the pituitary gland, which is observed during the death of cells that feed blood vessels.

A similar disease often occurs in the postpartum period, especially in those who have experienced large blood loss, as well as postpartum depression. The death of pituitary cells leads to a decrease in the amount of hormones they produce, so weight loss occurs, and dystonia, mental disorders, and hypotension are also observed.

Stages of the disease

Depending on weight loss and the characteristics of metabolic disorders, there are 3 main stages of cachexia:

• precachexia;
• cachexia;
• refractory disorders.

Precachexia is characterized by the fact that in six months a person loses about 5% of body weight, signs of an inflammatory process are observed in the internal organs, the patient refuses food, and metabolic disorders occur. The second stage is due to the fact that there is a weight loss of more than 5% or a decrease in skeletal muscles.

The refractory stage is characterized by metabolic disorders, the lack of a result of therapy, as well as severe exhaustion. In the last stages, a person completely refuses to eat, sometimes consciousness is disturbed, and life expectancy does not exceed 3 months.

Carrying out diagnostics

The doctor can make a diagnosis when examining the patient, since a sharp weight loss can be noticed almost immediately. However, in order to conduct competent and adequate therapy, it is imperative to conduct an examination to determine the cause that provoked the pathological process, as well as the stage of metabolic disorders.

When conducting a diagnosis, laboratory tests of blood and urine are required, and in some cases a fecal analysis. In the blood, there is a decrease in the amount of proteins, glucose and cholesterol. With the course of the inflammatory process, leukocytosis, a decrease in the erythrocyte sedimentation rate, and anemia are possible. The volume of urine decreases, and there is also a sharp increase in leukocytes and protein. In addition, instrumental research methods are assigned:

• electrocardiogram;
• fluorography;
• ultrasound diagnostics;
• x-ray;
• tomography;
• colonoscopy.

As a result of the diagnosis, consultation with a cardiologist, oncologist, psychiatrist, infectious disease specialist, and also a neurologist is required.

Features of treatment

Treatment of cachexia is carried out in a complex and requires compliance with certain rules. This is due to particular difficulties in eating food, as there is a violation of appetite and a change in the digestive organs.

The choice of a method for replenishing the lack of useful and nutrient substances depends largely on the patient's well-being, the functioning of the digestive system, and the degree of exhaustion of the body. The patient must adhere to the rules of dietary nutrition, which is developed individually for each person by a nutritionist. It is worth noting that malignant neoplasms lead to a loss of energy, and this increases the need for calories, so nutrition should be high in calories.

When the oral cavity is affected by fungal processes, antifungal drugs are prescribed, as well as rinsing with antiseptics. During the treatment of cachexia, the patient must be under laboratory control at all times, which will help to detect complications in a timely manner and eliminate them.

If the patient cannot independently consume food, then intravenous support is required, indications for which may be:

• inability to independently consume food;
• severe exhaustion and weakness;
• previous surgery;
• significant nutrient requirements.

In addition, doctors prescribe drug therapy, which includes steroids for rapid weight gain, enzymes, antidepressants. Lifestyle and physical activity play an important role in therapy.

Danger to life

The hallmark of cachexia is that rapid and involuntary weight loss occurs. In addition, the patient has atrophy of the muscular system, and this leads to malaise, the occurrence of pain. Over time, it becomes difficult for a person to perform limb movement. The disease very often leads to the death of the patient.

Forecast and prevention

The disease is considered practically incurable, it is often observed in patients with the last stages of oncology. The prognosis is poor with high mortality rates.

Prevention in this case implies the timely treatment of malignant neoplasms, drug addiction, alcoholism. In addition, it is important to eat a balanced diet and eat foods high in fiber.

And diseases of the gastrointestinal tract that occur with syndromes of impaired digestion and absorption of food (chronic enterocolitis, - condition after gastric resection, gastrectomy), psychogenic, long-term in chronic infectious diseases (tuberculosis, brucellosis, etc.) and purulent processes (abscesses, festering bronchiectasis, osteomyelitis), debilitating (especially nodular ), severe, malignant (cancerous K.), metabolic and energy disorders (Metabolism and energy) in endocrine diseases, especially with panhypopituitarism (pituitary K. - see Hypothalamo-pituitary insufficiency) , adrenal insufficiency, thyroid disease. To. at children is, as a rule, a consequence of a hypotrophy (see. Dystrophy at children ).

K.'s pathogenesis is determined by the disease that caused it, but in all cases it includes profound metabolic disorders with depletion of fat and carbohydrate reserves, increased protein catabolism and a decrease in its synthesis.

Clinically To. is shown by sharply expressed weakness, disability, sharp weight loss. which is often associated with signs of dehydration (Dehydration) , although in some cases hypooncotic (protein-free) edema of the subcutaneous tissue and accumulation of transudate in various body cavities are observed. In severe cases, weight loss can reach 50% or more. patients become pale, or sallow-gray, flabby, wrinkled: the subcutaneous tissue decreases sharply or disappears, often there are signs of vitamin deficiency (Vitamin deficiency) . Trophic changes in hair and nails are noted. Develops , often fall out ; the intestines are disturbed, stubborn ones are often noted. Sexuality decreases, in women it occurs. The volume of circulating blood decreases, usually reduced. Determined, hypoalbuminemia, often also iron- or B 12-deficient. Decreased glomerular filtration in the kidneys.

Cachexia is a state of extreme exhaustion of the body. Pathology is characterized by general weakness, a sharp progressive decrease in body weight and a slowdown in all physiological processes. These disorders are accompanied by asthenia, depression and other mental changes. Cachexia can be both an independent lesion and a complication of various diseases, and requires immediate medical attention.

Symptoms of cachexia

Cachexia is accompanied by the following symptoms:

• Rapid weight loss up to 50% of body weight and more;
• muscle weakness;
• Dehydration;
• Sleep disturbance;
• Decreased blood pressure;
• Tendency to infections;
• Loss of incapacity.

With exhaustion, the skin loses elasticity, becomes flabby, and also turns pale or acquires an earthy hue. This is due to dehydration, vitamin deficiency and the disappearance of subcutaneous tissue. There is a trophic change in nails and hair, stomatitis develops.

Cachexia is characterized by a variety of disorders of the gastrointestinal tract and genitourinary system. In women, amenorrhea appears due to a decrease in the volume of circulating blood. Avitaminosis is expressed mainly in hypoproteinemia, hypoalbuminemia, deficiency of iron and vitamin B12.

In addition to the listed lesions, the exhaustion of the body is accompanied by various mental disorders. With asthenia, irritability, tearfulness and a subdepressive state appear, which, as the pathology develops, are replaced by lethargy, apathy and lack of physical strength. In cases of exacerbation of the underlying disease that caused cachexia, confusion may appear in the form of an amental syndrome, as well as rudimentary or severe delirium. Often, exhaustion is accompanied by anxiety-dreary conditions, apathetic stupor, pseudo-paralytic syndrome, or other forms of mental disorders. Even if the cause of exhaustion has been eliminated, asthenia continues to be present for a long period.

Causes of cachexia

The totality of causes contributing to the development of cachexia can be divided into five groups:

• Nutrient deficiency in the body due to starvation, diseases of the esophagus, teeth or oral cavity;
• Insufficient absorption of useful elements due to diseases of the stomach and intestines, as well as operations on these organs;
• Increased need for proteins, fats and carbohydrates during rehabilitation after severe injuries or in the postoperative period;
• Rapid loss of vitamins and minerals in kidney damage or massive burn tissue damage;
• Acceleration of metabolic processes due to failures of the endocrine system, heart failure, infections.

Depletion is primary and secondary. The main causes of primary, or pituitary cachexia, are the following disorders:

• brain injury;
• Protracted psychogenic stress;
• Anorexia;
• Tumor or systemic lesion of the pituitary gland;
• Autoimmune hypophysitis;
• Chronic specific infection;
• Hemorrhage;
• Embolism.

The secondary or symptomatic type of wasting is due to the following factors:

• Malabsorption;
• Hypoinsulinism;
• Deficiency of glucocorticoids;
• Increased synthesis of glucagon;
• Excess production of somatostatin;
• growth of neoplasms.

Pituitary cachexia

Pituitary cachexia, or Simmonds syndrome, is a pathology caused by lesions of the base of the brain that lead to the development of functional hypothalamic-pituitary insufficiency. The main clinical manifestation is severe exhaustion in combination with senile involution of organs and tissues. The etiology of the disease, in addition to infection of the pituitary gland, includes tuberculosis, syphilis, necrosis after hemorrhage or embolism, sclerosis, tumor.

Pituitary cachexia usually proceeds slowly and may go undiagnosed for many years. But in some cases, depending on the nature of the lesion of the pituitary gland, all symptoms progress rapidly, and without treatment, cachexia leads to a coma and death.

According to statistics, the disease occurs mainly in women 30-40 years old. The first sign is a violation of the menstrual cycle, up to the complete disappearance of menstruation. Then exhaustion develops, secondary sexual characteristics disappear, internal organs atrophy, and mental health is also disturbed.

In the treatment of this type of cachexia, hormone replacement therapy is used:

• adrenocorticotropic hormone;
• deoxycorticosterone;
• sex hormones;
• Prednisolone and other glucocorticoids.

In addition, saline, glucose solution, vitamins are administered and high-calorie nutrition and rest are provided.

Cancer cachexia

Cancer cachexia is the depletion of the body against the background of the development of a malignant tumor. For the development of pathology, the localization and volume of the neoplasm do not matter, although with tumors of the gastrointestinal tract, exhaustion is more pronounced. It is believed that cancer cachexia is associated with the following phenomena:

• Atypical metabolism, which causes a high need for tumor tissue in the substrates used for its growth;
• The toxic effect of a tumor on the structures and functions of healthy organs and tissues.

As a result, the disease leads to irreversible deviations of homeostasis and death.

Treatment of cachexia in malignant tumors is symptomatic. In particular, delta-9-tetrahydrocannabinol is used as an antiemetic, including after chemotherapy, since medical cannabinoids significantly stimulate appetite and weight gain. With the help of fish oil, in some cases, weight loss is also stopped, but in general, this area of ​​\u200b\u200boncology is not well understood.

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

• Diseases of the esophagus (stenosis), in which it is difficult for food to enter the patient's stomach.
• Fasting for an extended 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, festering bronchiectasis).
• Cancer tumors.
• Diseases of the gastrointestinal tract, the consequences of which are the failure of the functions of digestion of food and the absorption of its mucosa (gastrectomy, enterocolitis, the consequences of gastric resection (celiac disease), and so on).
• Amyloidosis.
• Failure of the endocrine system, violation of metabolic processes (pathology of the adrenal glands and the work of the thyroid gland).
• psychogenic anorexia.
• Prolonged use of psychostimulants.
• Malnutrition.
• Diseases of connective tissues of a diffuse nature.
• Hypotrophy in young patients.
• Acquired immune deficiency syndrome (AIDS).

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:

• Rapid weight loss (severe cachexia indicates a loss of half of a person's normal weight).
• Loss of ability to work.
• Decreased general vitality.
• A dangerous loss of fluid by the body, 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, the color is unnaturally pale, gray-green.
• Increased fragility 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.
• Failure of intestinal peristalsis.
• Blood pressure is low.
• Constant feeling of cold.
• Decreased glomerular filtration in the kidneys.
• Reducing the volume of circulating blood.

Frequent mental disorders:

• Asthenia.
• subdepressive mood.
• Tearfulness.
• Clouding of consciousness.
• Apathetic stupor.
• The psycho-organic syndrome is less common.

Degrees of cachexia

Doctors distinguish three degrees of cachexia:

Hypothalamic form of the disease. It is characterized by 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, the metabolic transformations of triacylglycerols, cholesterols and phospholipids.
• Decreased activity of endothelial lipoprotein lipase (regulates the level of lipids in the blood, which is essential in atherosclerosis).
• There is a suppression of anabolism (metabolic processes).
• The transport of fats is slowed down.
• There is an intensification of catabolism (energy metabolism).

Cahechtinous form of the disease. It is accompanied by increased production of cachechtin, as a result of which the following are 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).
• The 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.
• Thymus hormone deficiency.
• Hypocorticism (pathological changes caused by hypofunction of the adrenal cortex).
• Hypoinsulinism (an endocrine disease characterized by attacks of a significant decrease in blood sugar).

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 environment, the external environment):

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

Endogenous causes (internal failures):

• Chronic stage of radiation sickness.
• Violation of the work of the adrenal glands.
• Senile involution of the organism.
• The presence of a malignant tumor.
• Violation of the endocrine glands.
• Myxedema (insufficient supply of organs and tissues of the body with thyroid hormones).
• Consequences of trauma.
• Terminal (dystrophic) form of chronic heart failure.
• Postoperative hypothyroidism (long-term, persistent lack of thyroid hormones).
• A significant decrease in mental activity.

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 (decrease in thyroid function) and hypogonadism (decrease 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 this pathology can be:

• Injury.
• Inflammatory process in the pituitary gland.
• Malignant or benign tumor.
• Bleeding and collapse during childbirth, followed by ischemia or vascular thrombosis in the hypothalamus-pituitary gland.
• 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 a pathology dominates the pituitary gland, and there is a sharp weight loss, doctors diagnose the cerebral form of the disease.

There are known cases of sudden weight loss, while studies have not revealed any abnormalities in the work of 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 onset 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.

Alimentary cachexia

If the cause of anorexia is prolonged malnutrition, malnutrition, voluntary or forced starvation, general exhaustion of the body develops, doctors refer this pathology to alimentary cachexia.

With such a pathology, a failure occurs 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 massive social status during 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 nutrients, vitamins and microelements necessary for normal functioning, which are a source of energy. This leads to a reduction in energy costs, loss of psychological, intellectual and physical capacity for work. There is a redistribution of the necessary substances, which contributes to a mismatch in the work and trophism of various systems and organs. The hormonal background undergoes restructuring (malfunction of the thyroid gland, glands of the reproductive system, adrenal glands). The restriction of protein food provokes hypoproteinemia, which is manifested by protein swelling.

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.

Malignant cachexia

Malignant cachexia is more likely to occur in patients suffering from the rapid decomposition of the tumor conglomerate, while the size of the tumor does not matter.

Causes of exhaustion:

• Intoxication of the body with toxins of cancer cells or "waste products" of concomitant complications.
• The accumulation of an excess amount of lactic acid, which has a detrimental effect on the state and functioning of the liver. The patient's body counteracts it by breaking down sugar in the blood, mobilizing its carbon reserve. It cannot make up for the loss.

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

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

Cardiac cachexia

As a result of a 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 coronary heart disease lead to a similar result. As a result, a person acquires heart failure. In severe forms of chronic heart failure, significant weight loss is observed. This pathology is classified as cardiac cachexia.

Until the end, the mechanism of the appearance and development of cachexia is not 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 stagnation of blood in the venous system.
• Persistent feeling of fullness in the stomach.
• An increase in the number of inflammatory cytokines.
• Violation of intestinal motility.

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

Senile cachexia

A person ages because his body ages. There is a slowdown in metabolic processes, the regeneration of the skin is slower, and so on, but the strong depletion of the body of an old person cannot be attributed to the norm. Often after the age of 50, there is a significant reduction in muscle mass, while the amount of fat increases. These are the consequences of a sedentary lifestyle, sedentary work, dietary restrictions.

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

Treatment of cachexia

Sharp exhaustion is already a consequence of external factors or some diseases that affect the body. Therefore, the treatment of cachexia is reduced to the elimination, first of all, of the causes that prompted progressive weight loss. If the wasting is a consequence of the disease, then the patient must undergo a full course of treatment. If cachexia was provoked by external factors, it is necessary, accordingly, to minimize their impact and undergo restorative therapy.

But a mandatory item in the normalization of the patient's condition is the systematic restoration of a balanced diet, careful care for him. Without fail, easily digestible proteins, vitamins, fats, foods rich in trace elements are introduced into the diet. If the patient has symptoms of a malfunction in the digestive tract and the suction system, the doctor prescribes polyenzymatic medications, such as pancreatin.

• Pancreatin

The volume of the prescribed drug depends on the age of the patient and the degree of lack of enzymes produced by the pancreas. The drug is taken before meals or with food, drinking plenty 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 of daily. For babies under the age of one and a half years, 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.

The contraindications of the remedy include:

• Individual intolerance to one or more components that make up the drug.
• Acute or chronic pancreatitis at the stage of exacerbation.

When taking the drug, side effects may occur:

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

If the patient is in serious condition, he is parenterally (bypassing the intestines - injections intramuscularly or intravenously) inject glucose, mixtures of amino acids, vitamins, protein hydrolysates. If necessary, the doctor connects anabolic steroids (for example, andriol).

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

• Glucose

The drug is administered both orally, intravenously, and by intramuscular injection. The dosage of one dose is 0.5 - 1 gram.

Subcutaneously or into a vein, glucose is supplied with a solution of 4.5 - 5% in an amount of 300 - 350 ml. In the form of enemas - up to two liters per day.

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

The only contraindication to the use of glucose may be the patient's diabetes mellitus.

• Andriol

The required dose is assigned by the attending physician purely individually, depending on the clinical picture. The recommended initial daily amount is 120-160 mg for two to three weeks, followed by a decrease in dosage to 40-120 mg daily. The capsule of the drug is drunk after a meal, 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 large dosage is taken in the morning.

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

• Periactin (Periactin)

The drug is attributed by the doctor to raise the patient's appetite. The adult dosage is:

• tablets - 0.5 - 1 piece three - four times a day.
• syrup - one - two teaspoons three - four doses per day.

Children aged two to six years - the maximum daily dose is two tablets or two tablespoons of syrup.

Children from 6 to 14 years old - the maximum daily amount of medicine is three tablets or three tablespoons of syrup.

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

• Primobolan-Depot (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 the rate of 1 mg per kilogram of the baby's weight once every two weeks.

The medicine is contraindicated in men suffering from prostate cancer and pregnant women.

Nutrition for cachexia

The diagnosis of wasting is made to a person if his weight deviates significantly from the norm. Just as it is a problem for obese people to lose weight, so for very thin people it is a real problem to gain weight and bring it back to normal. In addition to medical means, nutrition in case of cachexia is also capable of normalizing the patient's weight.

Such patients often lack appetite, and it is quite problematic to feed them. 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 the schedule. Eating at the same time causes the patient's digestive system to be stimulated. Dishes should be tasty and aesthetically appealing - 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 on rich broth or strong broth with dressing of sour cream, cream or egg yolks.
• Smoked fish.
• Peppered sauces.
• Spices.
• Fruit and vegetable freshly squeezed juices.
• Dessert.

If there are no medical contraindications, then you can eat everything. It should only be remembered that they must be high-calorie. It is also necessary to cook dishes using vegetable and butter oils, cream. The diet of such a patient must include:

• Muffin.
• Drinks containing a large amount 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 (spicy sauce, horseradish, adjika, lemon, mustard).

Salads consumed by the patient should contain:

• Boiled vegetables with butter.
• Vegetables fried and stewed.
• The perfect condiment is mayonnaise.

For a side dish in this case, fit:

• Cereal porridge seasoned with butter.
• Pasta.
• Boiled potatoes with butter.
• French fries.
• Potatoes - mashed with milk, cream or sour cream.
• Potato baked with fat.

Dessert can be taken not only at lunchtime, but also with another meal:

• Cottage cheese casseroles, pasta and cereals.
• Pies and kulebyaki.
• puddings.
• Desserts can be not only sweet, but also salty.

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, speaks of a neglected late stage of the disease and gives an unfavorable prognosis for recovery. If a sharp depletion is caused by other reasons, then such a patient has a chance to recover, but on the condition that adequate effective treatment is carried out, in compliance with the diet and lifestyle of the patient.

In nature, everything is harmonious and a deviation, both towards a large weight, and its sharp loss leads to serious illnesses, the final of which can be a fatal outcome.

Cachexia is not a sentence (except for oncological diseases) and it can be fought, but this must be done only under the vigilant supervision of a certified specialist. Self-activity in this case is inappropriate, because your life is at stake!

Cachexia is a pathological condition in which extreme exhaustion of the human body develops. Cachexia is not an independent disease. This is just one of the symptoms that can accompany many other serious illnesses. Therefore, with the development of cachexia, you should definitely consult a doctor and undergo a complete medical examination.

Cachexia is characterized by a slowdown in the rate of all physiological processes, a constant decrease in body weight, and an increasing general weakness. Often this pathological process is accompanied by the development of asthenic syndrome, depressive states and many other changes in the mental sphere of a sick person.

Symptoms of cachexia

Cachexia is characterized by the following symptoms:

• Very rapid and significant loss of body weight. It can reach fifty percent, and in some cases be even more;
• Dehydration of the body;
• Increasing muscle weakness;
• Increased susceptibility to infectious diseases, due to the deterioration of the immune system;
• Persistent hypotension, that is, a decrease in blood pressure;
• sleep disorders;
• Mental disorders that can lead to the patient's loss of legal capacity, which will require the organization of permanent care for him.

With cachexia, as a result of violations of the water-salt balance, vitamin deficiency and thinning of the fatty subcutaneous tissue, the skin loses its elasticity. As a result, they become flabby and acquire an earthy hue, or pronounced pallor.

Trophic disorders, that is, tissue nutrition, lead to increased fragility of nails, hair loss, and the development of stomatitis.

Cachexia is also accompanied by various disorders of the genitourinary system and organs of the gastrointestinal tract. In patients, libido decreases, and then completely disappears. Men develop persistent impotence, and women develop secondary amenorrhea.

Deterioration of the process of digestion and absorption of nutrients cause hypovitaminosis, and associated iron deficiency, hypoproteinemia.

Very quickly with cachexia, deviations in the mental sphere also occur. Patients develop increased irritability, subdepressive state, tearfulness, lethargy and apathy, lack of strength.

In the future, if you do not identify the cause of cachexia and do not eliminate it, clouding of consciousness occurs, up to the development of severe delirium. But even if it is eliminated in patients, signs of asthenic syndrome will still remain for a very long time.

Other forms of mental disorders in asthenia can be: pseudo-paralytic syndrome, apathetic stupor, anxiety-dreary states.

Causes of cachexia

Many reasons can lead to the development of cachexia. Currently, doctors conditionally divide them into several groups:

1. Insufficient intake of nutrients in the body. This can be caused by diseases of the esophagus, oral cavity, pharynx, as well as banal starvation;
2. Violation of the process of absorption of nutrients, due to a variety of pathologies of the gastrointestinal tract or surgical interventions affecting the organs of the digestive system;
3. Increased body's need for basic nutrients in the rehabilitation period after major surgical interventions, traumatic injuries;
4. Rapid excretion of trace elements and vitamins from the body, which can be observed with a massive burn injury or some kidney diseases;
5. A significant increase in the rate of metabolic processes associated with certain infectious diseases, cardiovascular pathologies, endocrine diseases.

Causes of primary, it is also called pituitary, cachexia can be:

• Severe stress of a psychogenic nature that continues for a long time;
• brain injury;
• Diseases of the pituitary gland, including tumors;
• Anorexia;
• Specific chronic infection, such as tuberculosis;
• Autoimmune hypophysitis, that is, an inflammatory process in the tissues of the pituitary gland associated with malfunctions in the activity of the immune system;
• Embolism;
• Significant loss of blood volume.

The causes of the secondary or symptomatic type of cachexia (wasting) are:

• Hypoinsulinism;
• Malabsorption syndrome;
• Deficiency in the production of glucocorticoid hormones;
• Increased synthesis of somatostatin;
• Excess production of glucagon;
• Malignant neoplasms, especially in the stage of decay.

Pituitary cachexia

Pituitary cachexia has another scientific name - Simmonds syndrome. Its development is due to damage to the structures of the brain, which causes the formation of functional insufficiency of the hypothalamic-pituitary system.

The main clinical manifestation of this pathology is the senile involution of tissues and organs, combined with severe general exhaustion.

The main causes of pituitary cachexia are syphilis, tuberculosis, necrotic lesions of the pituitary gland caused by embolism or hemorrhage in its tissue, tumor lesions, and sclerosis.

Most often, Simmonds syndrome develops slowly and may remain unrecognized for a long time. But with significant damage to the pituitary gland, the symptoms of cachexia can be rapidly progressive. In this case, delay in starting treatment leads to the development of a coma and death of the patient.

Pituitary cachexia predominantly occurs in young women under the age of forty. One of the first signs of the disease is the development of secondary amenorrhea, that is, the cessation of menstruation, not associated with pregnancy. As exhaustion further develops, secondary sexual characteristics begin to disappear, atrophy of the skin and internal organs occurs, and mental health suffers.

Therapy of pituitary cachexia is based on hormone replacement therapy, which includes the appointment of drugs of sex hormones, glucocorticosteroids, adrenocorticotropic hormone.

In cases where primary exhaustion is associated with an infection, then its active treatment is carried out.

If pituitary cachexia is caused by a pituitary tumor, the question is raised about its removal by surgery or radiation.

To correct metabolism, vitamins and maintain the water-salt balance, intravenous saline solutions, plasma and / or blood transfusions are prescribed. Vitamin therapy is indicated.

Cancer cachexia

Against the background of the development of malignant tumors, quite often there is a pronounced exhaustion of patients, called cancer cachexia.

The most noticeable depletion of cancer patients is noticeable when the tumor affects any parts of the gastrointestinal tract, but in other localizations of the malignant process, it is still present in varying degrees of severity.

The following causes lead to cancer cachexia:

• The decay products of the tumor poison the body, exerting a toxic effect on the functions of all other organs and systems;
• Any malignant tumor needs an increased consumption of nutrient substrates for its growth, which leads to the development of an atypical metabolism in the patient's body.

Progressive cancer cachexia causes irreversible changes in the homeostasis system of the body, which leads to the death of the patient.

Cancer cachexia is treated symptomatically only. Patients are advised to adhere to a dietary diet enriched with vitamins and with the inclusion of high-calorie, easily digestible meals.

With severe vomiting and nausea, antiemetic drugs are prescribed. To stimulate appetite and increase body weight, oncologists in the United States, Canada, and some other countries prescribe medical cannaboids, in particular delta-9-tetrahydrocannabinol, to their patients. In other countries, including Russia, their use is prohibited by law.

Currently, there are reports in the medical literature that slowing down weight loss in cancer cachexia is facilitated by the intake of fish oil by patients. But in general, the problem of cancer cachexia and its treatment is still very little studied by scientists.