Signs and Symptoms

Severe Malnutrition: Presentation, Symptoms and Complications

By Melanie Hebert, MD

What is Severe Malnutrition?

Severe malnutrition can accompany several chronic illnesses and infections, leading to significant and unintentional weight loss. Every system of the body is affected by severe malnutrition, leading to medical instability.

Unfortunately, most medical providers are not trained to identify or address life-threatening complications that accompany severe malnutrition, underscoring the need for severely underweight patients to be treated in dedicated medical stabilization units for severe malnutrition.

According to the World Health Organization a BMI of less than 18.5 kg/m2 qualifies as underweight for adults. A number of other criteria define severe malnutrition including low energy intake, weight loss, loss of subcutaneous fat, loss of muscle mass, fluid accumulation, and decreased hand grip strength.


Causes of Severe Malnutrition

  • Liver failure: Advanced liver disease can lead to malnutrition. No longer able to process and absorb nutrients from food along with decreased food intake from other factors such as decreased taste, socioeconomic challenges, and substitution of calories by alcohol, individuals with liver failure and malnutrition face an increased mortality risk.

  • Cancer: Appetite loss is common for many cancer patients, potentially leading to malnutrition. Patients with late-stage cancer may also develop a wasting disorder, cachexia, that is associated with a reduced quality of life and higher mortality risk.
  • HIV and AIDS: Malnutrition and weight loss (“wasting”) are core features of the progression of HIV and AIDS, increasing rates of impairment and mortality.  Physical changes to the intestines along with side effects of medications and opportunistic infections all play a role in the development of malnutrition.
  • Nontuberculous mycobacteria (NTM) infection: NTM organism infection can lead to lung disease, weight loss, loss of muscle and malnutrition.
  • Inflammatory bowel disease (IBD): Inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis can also lead to malnutrition both with complications of malabsorption as well as avoidance of nutrition due to the adverse consequences of diarrhea, pain, cramping, and bloating that can result from eating.
  • Other cause of malnutrition: Eating disorders, over active thyroid disease (hyperthyroidism), chronic or acute intestinal infections such as parasitic infections, and malabsorptive syndromes are all additional examples of conditions that can lead to malnutrition.

People who are chronically ill may display a severely low weight such as a BMI less than 15 or weight lower than 70 percent of Ideal Body Weight (IBW). While we can’t always prevent serious and chronic illnesses or malnutrition from developing due to these illnesses, medical professionals can offer timely, appropriate intervention of these complications.  At this low weight, a host of medical complications may appear:


Symptoms & Complications of Severe Malnutrition

  • Cardiac: Palpitations, light headedness, dizziness, and chest pain can be indications that serious cardiac complications have developed.  Some of these include myocardial atrophy, mitral valve prolapse, pericardial effusion, sinus bradycardia, orthostatic hypotension, and even sudden cardiac death
  • Gastrointestinal: Constipation, diarrhea, fullness, and abdominal pain are all indicators of potential gastrointestinal complications from such diagnosis as gastroparesis, superior mesenteric artery (SMA) syndrome, liver disease, and functional bowel disorders.
  • Pulmonary: The development of shortness of breath and fevers can be revealing of a spontaneous pneumothorax and pneumomediastinum, aspiration pneumonia, in concert with abnormal pulmonary function tests.
  • Endocrine: Symptoms from endocrine complications are often vague but can reflect low leptin levels, growth hormone resistance, elevated serum cortisol levels, euthyroid sick syndrome, hypoglycemia, and resultant amenorrhea.
  • Muscle & Bone: Usually painless, sarcopenia and bone loss (osteopenia and osteoporosis) are complications from severe malnutrition.  However, osteoporosis may be irreversible with significant malnutrition, and severe fractures can occur with low bone density.
  • Neurologic: Cognitive deficits as a result of generalized brain atrophy.  Numbness and tingling can also occur.
  • Dermatologic: Manifestations include xerosis, acrocyanosis, lanugo hair growth, brittle hair and nails and unexplained hypercarotenemia

Unfortunately, individuals suffering from severe malnutrition can’t simply “eat more” or “gain weight” to recover. In fact, they run the risk of developing refeeding syndrome, a potentially fatal metabolic disturbance, if they try to eat too much or gain weight too quickly.


The Risk for Refeeding Syndrome

Patients with severe malnutrition who try to gain weight or eat too much, too quickly, could be at risk for a fatal condition called refeeding syndrome. The lower a patient’s weight is, the higher the risk for complications during refeeding.

Marked by a shift in fluids and electrolytes within the body, the shifts associated with refeeding syndrome are due to moving from a state of tissue breakdown (catabolism) to a state of building up of tissue (anabolism).

Due to the risk factors involved with refeeding and the potential for fatal complications, the experts at ACUTE closely monitor all patients during each phase of treatment to prevent — or address — refeeding syndrome.


Treatment for Severe Malnutrition

For many individuals, the discomfort of the symptoms associated with severe malnutrition is an urgent catalyst to seek treatment. Yet, physicians in traditional medical settings are unlikely to have the specific expertise that is needed to treat this life-threatening condition.

Patients with advanced and/or chronic illness have a high prevalence of depression and anxiety related to living with major illness. Our medical and behavioral teams collaborate to meet any patient treatment need, addressing most medical diagnoses and psychiatric issues concurrently. There is no other unit in the U.S. capable of this tandem approach and long-standing excellent patient outcomes

Dr. Philip S. Mehler, Founder and Chief Executive Officer of ACUTE

Nutritional rehabilitation offers a life-saving opportunity for severely malnourished patients with a BMI less than 15. But if you are looking for treatment for severe malnutrition, the safest choice is to seek consultation with medical experts who have a deep understanding of the medical complications that can occur when treating extremely underweight patients: 

  • Managing blood chemistry abnormalities
  • Avoiding refeeding syndrome
  • Managing complications from chronic vomiting and other forms of purging
  • Managing nutritional rehabilitation alongside advanced disease or infection
  • Supporting a safe appropriate rate of weight restoration in conjunction with helping patients tolerate the discomfort of refeeding

ACUTE is the only dedicated inpatient medical stabilization program in the country with the resources, environment and experience to treat the most medically severe cases of malnutrition. Offering refeeding, medical stabilization, care for co-occurring diagnoses and other therapies helpful to recovery, ACUTE utilizes customized treatment regimens, including tube feeding, enteral and parenteral nutrition when oral feeding is not indicated. Upon achieving medical stability, ACUTE seamlessly returns patients to their treatment center to continue their recovery.


Seeking Treatment for Severe Malnutrition

No matter where you live, or the complexity of your medical situation, ACUTE can help you gain weight and restore nutritional status — giving you the best opportunity for hope, survival and recovery. Here at our unit, our experts provide care for both your medical diagnosis and malnutrition concurrently, simultaneously addressing:

  • Weight restoration
  • Nutritional rehabilitation
  • Emotional concerns
  • Strength and mobility
  • All other medical concerns

Since 2002, we have saved thousands of lives. Our providers are thoughtfully trained in culturally responsive care with the goal of helping all patients live a healthy and affirmed life. Bringing confidence, compassion and knowledge, we offer hope when all other medical care has failed.

No patient is too sick for ACUTE. We work closely with air ambulance transport providers to ensure that patients facing extreme medical instability are not denied treatment. To help these patients get the lifesaving care they need, ACUTE partners with elite air ambulance providers to get patients to our unit at Denver Health safely and swiftly, usually within 48 hours.


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ACUTE Earns Prestigious Center of Excellence Designation from Anthem
In 2018, the ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health was honored by Anthem Health as a Center of Excellence for Medical Treatment of Severe and Extreme Eating Disorders. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. It comes after a rigorous review process.

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