Like the death camps in WW II the camps held people nearly dead of starvation.
they had to be carful on feeding them as sugar would kill them in that state.
how and what did they feed them and how long before they were able to eat lots
I think it took months to get them to a normal diet. when they realised that the food was killing the victims they briefly returned to the diet of weak cabbage water
Refeeding syndrome is still an issue these days, but the main causes are anorexia nervosa, alcohol abuse, being nil-by-mouth as a hospital in-patient (usually surgical patients) and diabetic ketoacidosis (DKA).
When one isn’t eating (enough), instead of aerobic metabolism, one’s body changes to anaerobic metabolism, and insulin secretion is significantly decreased. Once food intake increases, insulin secretion increases, and uses up the already small amounts of potassium, magnesium and phosphate. They can drop to dangerous levels and the main thing we’re worried about is cardiac arrhythmias*. If we think this is a problem, we do bloods twice or thrice a day on ward patients, or more frequently in ICU.
Depending on the cause, they can be eating normally again well within a week. If the cause is being NBM for surgical reasons, they’re usually eating normally again within four days – day 1 is clear fluids, day 2 is free fluids, day 3 is light diet and day 4 is normal diet. If it’s a concentration camp victim, they take longer because they’ve been starved for longer and their stomach and rest of GIT have physically shrunk. But regardless, the electrolytes are sorted within a week.
*As an aside, I once attended a code blue on someone who had a cardiac arrest while visiting a patient. This person’s magnesium level was 0.07, normal being ~1. ‘E had anorexia nervosa.
Presumably aid agencies are all over this stuff.
Yes; I read an article yonks ago about how they changed the composition of what they gave people initially and later, to minimise the risk.
Came across a surgical registrar once who was adamant their patient didn’t have refeeding syndrome…the consultant called them an idiot and had the patient moved to ICU. Was hilarious to not be the reg (or the patient).
Temporary therapeutic foods
Malnutrition is a medical condition, not just a lack of food. The bodies of severely malnourished children are unable to process regular food. Instead of being fed food such as rice or porridge, children are fed therapeutic foods for up to one month, or until their bodies are able to process traditional foods. There are three main types of therapeutic foods in use; these consist of powdered milk formulas named F-75 and F-100 and a ready-to-eat peanut paste named Plumpy’nut. F-75 and F-100 are formulated specifically for the severely malnourished, to be used only under supervision. Plumpy’nut can be used at home without supervision.
F-75 (phase 1 therapeutic milk): a milk based powder mixed with water, that is given to severely malnourished children when they first arrive for treatment. It is normally given for one to three days, in cases of kwashiorkor it can be given for a maximum of seven days. It is not intended to cause the child to gain weight, but only to condition the body to digest food.
F-100 (phase 2 therapeutic milk): a milk based powder mixed with water. It contains more protein and calories than F-75, and is designed for rapid weight gain, and to prepare the body for digestion of normal food. It has been criticized as very ineffective compared to the “breakthrough” invention of Plumpy’nut.
Plumpy’nut: a ready-to-eat mixture of peanut paste, milk powder, sugar, fats, minerals and vitamins. This is the newest of the three, and is generally used as an alternative to using F-100.
After the malnourished children recover enough to be able to digest complex foods, products containing higher levels of protein can be used to increase muscle growth. Plant protein foods such as textured vegetable protein have been advocated, aside containing high amounts of protein, they also have a long shelf life and are inexpensive. Also, similar to tofu, plant protein can be manufactured in a sustainable way, unlike animal protein. This is an important question in areas such as Darfur, where cattle farming contributes to constant destruction of arable farmland.
Plumpy’nut has two main advantages over F-100: it comes in a ready-to-eat packet that requires no water or mixing; and it puts mothers in charge of feeding their own malnourished children in their own communities, rather than forcing them to always bring their malnourished children to hospitals or therapeutic feeding centers for assistance. The Wall Street Journal noted: “Nutritionists for the first time can take treatment beyond crowded emergency feeding centers and hospitals settings, where disease can spread rapidly, and into communities where malnourished children live.”
http://en.wikipedia.org/wiki/Famine_relief#Temporary_therapeutic_foods
Heh.
We have a dietician who is adamant our DKAs are all going to get refeeding syndrome, despite getting >240 IV dextrose daily from admission as well as oral intake as tolerated…
That’s ridiculous, everyone knows that powdered milk formulas are just a plot by evil multinationals.
I love powdered milk formulae being given to most of the non-Caucasian population of the world…
OCDC said:
I love powdered milk formulae being given to most of the non-Caucasian population of the world…
Why…
dv said:
OCDC said:
I love powdered milk formulae being given to most of the non-Caucasian population of the world…
Why…
OCDC said:
dv said:
OCDC said:
I love powdered milk formulae being given to most of the non-Caucasian population of the world…
Why…
Because up to 90% of Africans are lactose-intolerant…
ROFL.
Winners.
Presumably in a famine relief context, lactose intolerance is less severe a problem than dying from starvation.
Bubblecar said:
Presumably in a famine relief context, lactose intolerance is less severe a problem than dying from starvation.
ummm…
One can become dehydrated from the volume of stool lost in severe lactose intolerance. And if one doesn’t have access to clean water, replacing that fluid can be a problem…
poikilotherm said:
Bubblecar said:
Presumably in a famine relief context, lactose intolerance is less severe a problem than dying from starvation.
ummm…
?
OCDC said:
One can become dehydrated from the volume of stool lost in severe lactose intolerance. And if one doesn’t have access to clean water, replacing that fluid can be a problem…
So how do lactose intolerant infants even survive …
And if one doesn’t absorb the carbohydrates in milk, that’s a lot of the benefit gone…
One of the benefits of Plumpy’nut is that it doesn’t require added water, but it still contains powdered milk.
dv said:
OCDC said:
One can become dehydrated from the volume of stool lost in severe lactose intolerance. And if one doesn’t have access to clean water, replacing that fluid can be a problem…
So how do lactose intolerant infants even survive …
Congenital lactase deficiency, in which lactase is never expressed, used to be associated with death during infancy.
Bubblecar said:
One of the benefits of Plumpy’nut is that it doesn’t require added water, but it still contains powdered milk.
And like the therapeutic milk, it’s widely used in Africa. So presumably is doing more good than harm.
OCDC said:
dv said:
OCDC said:
One can become dehydrated from the volume of stool lost in severe lactose intolerance. And if one doesn’t have access to clean water, replacing that fluid can be a problem…
So how do lactose intolerant infants even survive …
Wild-types express lactase in infancy and early childhood, then it stops being expressed at around the same time as weaning occurs. Mutants (ie Europeans) continue to express lactase life-long.Congenital lactase deficiency, in which lactase is never expressed, used to be associated with death during infancy.
As I understand it, a larger proportion of Asian people are lactose intolerant. So why is it that milk exports to Asia are increasing amazingly in the last few years? What are they doing with it?
buffy said:
As I understand it, a larger proportion of Asian people are lactose intolerant. So why is it that milk exports to Asia are increasing amazingly in the last few years? What are they doing with it?
It is mainly milk powders that they use. Perhaps the buy lactose free products.
buffy said:
As I understand it, a larger proportion of Asian people are lactose intolerant. So why is it that milk exports to Asia are increasing amazingly in the last few years? What are they doing with it?
Buying it to keep in the fridge as a status symbol.
I’m not kidding – i’d bet that at least of few of them are.