STARVATION

Dr.Abhishek Karn
Asst. Professor
Dept. of Forensic Medicine &
Toxicology

May

occur either from actual

withholding of food or from the
administration of unsuitable food.

Types:1.Acute:

results from sudden &

complete stoppage of food.

2.Chronic:

results from gradual

deficient supply of food.

Starvation

deaths may be due to:

1.Famine
2.Being

trapped in mines, pits or

landslides
3.Neglect on the part of the
parents/guardians
4.Willful withholding of food

Symptoms of Acute Starvation:

In

acute starvation, there is a

feeling of hunger for the 1st 30 to 48
hrs(1.5 -2 days), which is followed
by pain in the epigastrium which is
relieved by pressure.

After

4-5 days of starvation, general

emaciation & absorption of the
subcutaneous fat begins to occur.

The

eyes are sunken

and glistening; the
pupils are dilated.

The

cheeks sink and the

bony prominences
becomes visible.

The

lips are dry and

cracked, and the tongue
coated and dirty, and
thirst is intolerable.

The

saliva is thick and scanty.

The

voice is weak and whispering.

The

skin is dry, rough, thin,

inelastic, wrinkle and pigmented.

Constipation
The

is usual.

urine is scanty, turbid and

highly concentrated and shows
evidence of acidosis.

As

starvation continues, at first rapid

mobilisation of protein stores occur
which are converted by liver to
glucose, which is mainly used to
supply energy to the brain.

This

is followed by a reduction in the

utilisation of proteins. As complete
depletion of fat stores approaches,
protein is again rapidly used as a the
source of energy.

Usually

loss of 40% of body weight

is fatal.
Intellect

remains clear till death,

though in some cases delusions &
hallucinations of sight & hearing
occurs.

Symptoms of Chronic starvation:

The changes are constant & develop
in a constant order.
1.Loss of well being, hunger & hungerpains.
2.Mental & physical lethargy & easy
fatigue.
3.Progressive loss of weight, rapid in
1st 6 months.

4.
5.
6.
7.
8.

Increasing cachexia, anemia.

Hypothermia
Extreme lethargy, gross mental
retardation & loss of self respect.
Oedema in feet & lower limbs.
Decreased resistance to infectionsdiarrhoea, dysentery, TB.

Blood sugar, chlorides & cholesterol

are lowered.

Non-protein nitrogen is raised.

CAUSE OF DEATH:
Exhaustion
Circulatory

failure

Intercurrent

infection.

FATAL PERIOD:
Withdrawal of both food & water:10-12 days.
Withdrawal

of food alone:- 6-8

weeks.
(Death usually occurs when 70-90%
of body fat & 20% of body protein
are lost)

FACTORS INFLUENCING THE

FATAL PERIOD:
1.Age
2.Sex
3.Condition

of body
4.Environmental temperature
5.Physical exertion

PM appearance:
All

t/s & organs show changes similar

to premature senility.

Extreme

emaciation (general reduction

in the size & weight of all organs)

Atrophy

of m/s.

Atrophy

of liver (may show necrosis).

Fat

almost completely absent in s/c

t/s, omentum, mesentery & about
internal organs (only in chronic
cases)

Ascites
Heart

in 10% of cases.

is small from atrophy &

chambers are empty.

Gall

bladder is distended with bile.

Spleen

is shrunken.

Atrophy
Marked

of nephrons in kidney.

anemia (blood volume

markedly reduced)

MEDICOLEGAL ASPECTS:
Exclusion of d/s likely to cause loss of
weight (eg. Malignant d/s, DM, TB,
chronic diarrhoea, Pernicious anemia,
progressive muscular atrophy etc.)
If

marked weight loss & especially the

absence of fat are found during
autopsy & there is no evidence of d/s,
diagnosis of death due to starvation
can be made.

Disuse
Loss

atrophy of GIT.

of weight, acidosis with ketone

bodies in urine are the criteria to
advise forced feeding.

Suicide:

voluntarily for the purpose of

exhibition, to attract public attention
etc.

Homicide:

illegitimate child, aged,

feeble minded etc.

Accidental:

during famine, trapped in

mines/pits/landslides/ship wrecks.

TREATMENT:
Warm

environment.

Complete
Liquid
Oral
f/b

bed rest.

diet + i.v. glucose + vitamins

protein concentrates.

semi solid & finally solid diet.

THANK YOU