ANOREXIA AND CACHEXIA

Anorexia is loss of desire to eat. Cachexia is a complex metabolic syndrome, characterized by profound loss of lean
body mass, in terminal illnesses.

Causes

  • Nausea and vomiting, constipation, gastrointestinal obstruction
  • Sore mouth, mouth tumours, malodour
  • Hypercalcaemia, hyponatraemia, uraemia, liver failure
  • Medications
  • Depression

Management

  • Treat underlying causes if possible.
  • In cancer patients, give corticosteroids for one week only, under supervision of specialist
    • Prednisolone 15-40 mg once a day for 7 days
    • Or dexamethasone 2-6 mg in the morning for 7 days

Non-medicine treatment

  • Small amounts of food frequently
  • Give energy-dense food, and limit fat intake
  • Avoid extremes in taste and smell
  • Pleasant environment, nice presentation of food
  • Eating is a social habit and people eat better with others
  • Nutritional counselling
  • If prognosis <2 months, counsel patient and family to understand and adjust to reduced
    appetite as a normal disease process

Caution

  • In established cancer and cachexia, aggressive parenteral and enteral nutritional supplementation is of
    minimal value