1/6. Evidence for an anabolic action of essential amino acid analogues in uremia and starvation.nitrogen-free analogues of essential amino acids, when administered with those essential amino acids for which analogues are ineffective or unavailable, exert three actions that may be beneficial in protein-deficient or protein-intolerant subjects. First, they bring about an increase in the concentrations of essential amino acids in the blood at the expense of the concentrations of certain non-essential amino acids, notably alanine and glutamine. This effect is most readily demonstrated in children with congenital defects of the urea cycle enzymes, but can also be seen during daily therapy of adults with portal-systemic encephalopathy. Second, these compounds promote nitrogen balance through their suppressive effect on urea synthesis (an effect not attributable to re-utilization of ammonia derived from urease action in the gut). This action is demonstrable in obese subjects who are already conserving nitrogen maximally at the end of a prolonged fast and can also be shown in the first week of fasting when the branched-chain keto acids alone are administered. In both situations, improved nitrogen conservation persists long after the analogues are metabolized, suggesting enzyme adaptations. In chronic uremics, nitrogen balance can be maintained in some (but not all) patients on very low nitrogen intakes. Third, these mixtures may delay or reverse the progressive decline in glomerular filtration rate characteristic of chronic renal failure in some cases: thus, for example, 5 of 6 patients taken off chronic dialysis have maintained lower serum urea concentrations without evidence of protein malnutrition for periods of 2-24 months.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
2/6. Does the expert witness fit the crime? Injury to a child by starvation--a dietitian's testimony.After the death of their four-month-old infant, the parents were charged with injury to a child by starvation. The medical examiner documented blunt force trauma and severe malnutrition at autopsy, but the cause of death was undetermined. The legal team hired a neonatal dietitian who was able to determine that impaired growth only occurred when the infant was in the care of his parents. This information, along with other testimony, established that the lack of nutrition compromised this infant's ability to grow and develop normally, and thus contributed to the infant's death. A jury found the father guilty of injury to a child with intent, and was sentenced to 50 years in prison. The mother agreed to a plea bargain serving 25 years. The purpose of this report is to offer insight, information, and facts from this case for the benefit of others.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
3/6. Criminally prosecuted cases of child starvation.OBJECTIVE: Here we describe the clinical findings and legal outcomes in 12 prosecuted cases of infant and child starvation. methods: medical records, investigation records, and transcripts of court testimony were reviewed in the cases of 12 infants and children from locations throughout texas who had been starved deliberately. The children's ages ranged from 2 months to 13 years. The caretakers of all children received both civil and criminal charges; cases were tried over an 11-year time span. Clinical presentations, examination findings, laboratory findings, symptoms of refeeding syndrome, and legal outcomes were examined. Two illustrative cases are presented in detail here. RESULTS: Of the 12 cases reviewed, the median age was 2.7 years, with a range of 2.25 months to 13 years 7 months. Half of the children died shortly before or soon after presentation for medical care or to law enforcement. survival was more common in older children than in infants. Most of the children were secluded from others, and all had access to food denied or severely restricted. Caretakers claimed few, benign, or no past medical illnesses in the children. Based on weight and height measurements, 10 of the children had severe wasting and stunting, and 2 had mild or moderate wasting. There was a tendency toward more severe wasting in the fatal cases. All children manifested multiorgan effects of starvation. All survivors manifested complications with refeeding. Approximately half of the children had past or present injuries or history suggestive of physical or sexual abuse. Parental rights were terminated in all cases. A total of 25 individuals were charged criminally; 23 were found guilty or pled guilty, and trials for 2 individuals were pending at the time of this writing. The types of criminal charges and punishment varied from deferred adjudication to a life sentence. CONCLUSIONS: life-threatening criminal starvation of infants and children is a rare and severe form of child maltreatment. In our series, infants were more wasted at the time of presentation and less likely to survive prolonged starvation than were older children. As with other forms of child abuse, caretakers' histories regarding the children's illnesses were inconsistent with the severity and chronicity of the children's degree of wasting. All victims in our series showed multiorgan effects of chronic malnutrition and deprivation, and all survivors developed refeeding complications and required prolonged periods of recovery.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
4/6. infanticide by starvation: calculation of caloric deficit to determine degree of deprivation.A review of medical records and autopsy examination of a six-week-old male revealed the cause of death to be severe malnutrition with dehydration. Weight and caloric deficits were calculated to determine the degree of deprivation, which could be expressed as an interval of days for clear courtroom presentation. These calculations may be useful for quantifying the degree of malnutrition in a variety of child abuse cases.- - - - - - - - - - ranking = 2keywords = malnutrition (Clic here for more details about this article) |
5/6. Altered consciousness and shock in a malnourished child.A 3-year 9-month-old child presented unresponsive, dehydrated, and in shock, a consequence of child neglect, abuse, and starvation. This scenario provides the vehicle for a discussion of three problems which can be precipitated by child neglect, specifically kwashiorkor, central pontine myelinolysis, and intellectual repercussions of malnutrition.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
6/6. starvation injury after gastric reduction for obesity.Gastric reduction operations are designed to control body weight by establishing a small, meal-size juxtaesophageal, gastric pouch that empties into the jejunum (gastric bypass) or the larger portion of the stomach (gastroplasty). If the outlet of the pouch is too small, a patient may be limited to ingesting clear liquids. vomiting then occurs if heavier liquids or normal foods are taken. An occasional patient has difficulty eating properly and vomits even though the pouch volume and outlet are of optimum size. For a patient who reports vomiting, a distinction must be made between episodic improper eating and uncontrolled starvation. Three types of starvation injury are described: (1) sudden death from protein malnutrition; (2) refeeding syndrome; and (3) Wernicke-korsakoff syndrome. The mechanisms of the development, manifestations, prevention, and treatment of these complications are explained. Surgeons who treat severe obesity should be aware of these complications and be prepared to manage patients who have uncontrolled vomiting so that such complications either do not develop or are recognized and treated as early as possible before serious and irreversible injury occurs.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |