Diagnosis is made by history and physical examination. Optional medical device diagnostics – depending on the results of the history, physical examination, and laboratory diagnostics – for differential diagnostic workup Electrical impedance analysis (measurement of body compartments/body composition) – for determination of body fat, extracellular body mass (blood and tissue fluid), body cell mass (muscle … Cachexia: Diagnostic Tests
A risk group indicates the possibility that the disease may be associated with the risk of vital substance deficiency (micronutrients). Complaint energy and protein malnutrition indicates vital nutrient (macro- and micronutrient) deficiency for: Vitamin A Vitamin B1, B2, B3, B5, B6, B12 Vitamin C Vitamin D Vitamin E Folic acid Vitamin K Magnesium Iron Iodine … Cachexia: Micronutrient Therapy
The following symptoms and complaints may indicate cachexia (emaciation): Leading symptoms Weight loss Loss of muscle mass/reduced muscle mass, especially noticeable on the temples and upper arms Paleness Decreased efficiency Note: Cachexia can occur on overweight patients! Associated symptoms Alopecia (hair loss) Anemia (anemia) Bitot spots – whitish spots on the cornea caused by vitamin … Cachexia: Symptoms, Complaints, Signs
Pathogenesis (development of disease) A person’s normal energy requirements are composed of resting metabolic rate, consumption during physical activity, and thermogenesis. In cachexia, metabolism is shifted from the anabolic (building up) to the catabolic (breaking down) side; accordingly, there is not only a complete depletion of storage fat depots but also a generalized atrophy (“emaciation”) … Cachexia: Causes
Medical history (history of illness) represents an important component in the diagnosis of cachexia. Family history Social history Current anamnesis/systemic anamnesis (somatic and psychological complaints). Do you often feel tired and unable to perform? Have you noticed any changes in your skin/hair? Do you have any wound healing problems? Do you have diarrhea? If so, … Cachexia: Medical History
Important parameters for differentiation into wasting, cachexia, and sarcopenia. Parameters Wasting Cachexia Sarcopenia Weight ↓ = to (↓) = up to (↓) or ↓ Body cell mass ↓ ↓ ↓ (muscle) Function ↓ ↓ ↓ Anorexia nervosa ++ – until (+) – until (+) Energy consumption = to (↑) ↑ = to (↑) Immunity = … Cachexia: Or something else? Differential Diagnosis
Nutritional therapy should be started early in cachexia, especially to promote treatment of the disease, because good nutritional status can improve the effects of therapy. The diet should be high in energy and protein. In addition, special nutrients should be administered. These are vitamin E, the amino acid arginine, and the omega-3 fatty acids docosahexaenoic … Cachexia: Nutritional Therapy
The following are the most important diseases or complications that may be contributed to by cachexia: Respiratory system (J00-J99) Decrease in respiratory muscles with subsequent limitation of respiratory function. Pneumonia (inflammation of the lungs) Skin and subcutaneous (L00-L99) Decubital ulcers (“bedsores”). Wound healing disorders Cardiovascular system (I00-I99) Cardiac arrhythmias Reduction of cardiac muscle mass Infectious … Cachexia: Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height [determination of BMI]; further: Inspection (viewing). Skin, mucous membranes, and sclerae (white part of the eye) [pallor, “hunger belly,” alopecia (hair loss), Bitot’s spots – whitish spots on the cornea caused by … Cachexia: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Urine status (rapid test for: Nitrite, protein, hemoglobin, erythrocytes, leukocytes, urobilinogen) incl. sediment, if necessary urine culture (pathogen detection and resistogram, that is, testing of suitable antibiotics for sensitivity / resistance). Electrolytes – … Cachexia: Test and Diagnosis
Therapy goals Avoidance of complications Appetite stimulation Therapy recommendations In drug therapy for the various forms of malnutrition, the underlying disease should first be identified and treated. Furthermore, nutritional counseling including nutritional analysis or therapy (if necessary, by means of a protein-energy supplement, ie, a fully balanced diet for the dietary treatmentof persons with catabolic … Cachexia: Drug Therapy