Starvation

Raghad Bashar
Forensic
medicine.
F2
The sequence.
• Body at rest needs 20 to 25 cal /kg. For person with weight of 70 kg
he will need 1400 to 1750 cal /day.
• In starvation cases , the body uses carbs (stored glycogen in first 6 to
24 hrs).
• Total body glycogen is roughly 500 g (400 in muscles ,100g in
liver)which roughly gives 2000 cal.
• After 24 hrs the fat and protein metabolism is started(fat metabolism
rate is greater than Protein).
• Fat metabolism releases ketones (increases acidity of blood).
• Fat in male constitutes 20 to 25% of their weight but in females it
constitutes 25 to 60 rof ygrene edivorp nac hcihw ,30%to 70 days.
• Lets do the math!!
• For 70 kg male the fat constitutes 14to 17 kg , every gram of fat gives
9 cal , turn the kilo to gram and multiply by 9 the total calories will be
3 ^10*126to / lac fo deen egareva eht yb meht edived ,3^10*157
’tel( yads say 2000cal) and you will get the#
• Protein metabolism starts after 72 hrs ,rapid , slow ,rapid manner.
• Problems happen when the individual loses up to 18% of his
weight.In our ex that would equal 13 kilo.
• Syms like muscle weakness, syncopal episodes, decreased mental
alertness , after roughly 40 days Wernicke’s syn can develop
(deficiency of B.)egamad niarb sesuac ,1
• When weight loss reaches 35 to .rucco ot nigeb shtaed,50%
• As the starvation continues the lethargy becomes extreme with
mental impairment and loss of interest in every thing.
• AT AUTOPSY:
-complete lack of fat in subcutaneous and deep fat depots.
-skin is pale and cadaveous in .17.5% ni nworb krad &82.5%
-severe atrophy of skeletal muscles, heart, liver,spleen and kidney but
not brain.
-peritoneal effusion may occur.
-edema in .ssol thgiew fo tnuoma ehT ksam yam ,33%
-small bowel wall is swollen & reddish mucosa in .27%
-pseudysentry in .)asocum noloc fo notiareclu(50%
-pressure sores, dental caries and diper rash may occur.
Death
• Due to inf , arrhythmia or hypoglycemia.
• Death is accelerated by lack of adequate hydration.
• Starvation vs malnutrition/undernutrition???
In cases of dementis , CA , anaroxia nervosa pt becomes malnourished.
In cases of child abuse with no feeding it is starvation and considered
homicidal.
Formula for investigating child starvation contains info like:feeding hx ,
formula type ,birth records, recent illness, ill contact , death of siblings,
immunization status.
Investigation of starvation related deaths.
• Difficult since the forensic pathologist has to differentiate b/wn
cachexia and starvation due to:
natural death from lack of food vs intentional withholding of food.
CONCLUSION??
Death related to starvation needs death investigation +complete
autopsy examination+exclude other dz process+ review of all medical
record to check for reduction in body weight.