Thai Cave Rescue 'if they've had very few calories so far, then they'll still be in the starvation stage

#ThaiCaveRescue - really interesting input to World Extreme Medicine from Karen Allsopp a Specialist ICU Dietitian in Macclesfield which is useful to share

'You asked at what point the boys' metabolisms will be now.'

...'if they've had very few calories so far, then they'll still be in the starvation stage - where the body adapts by minimising insulin levels, and running with low blood glucose levels and adjusting renal excretion of electrolytes down to a minimum.

Once calories are introduced - which for hospital patients in the first instance is often as iv dextrose - the levels of insulin rise quite abruptly - especially if the calorie input is high. Blood glucose levels will rise, sometimes to above 8 mmol/L even in non-diabetics. This shift to anabolism, drives movement of potassium, magnesium and phosphate from the blood into the intracellular space. This can result in hypo-kalaemia/ magnesaemia/ phosphataemia with potentially serious consequences. 

The introduction of carbohydrate can also 'use up' the last remaining supply in the body of thiamine, tipping the patient over into acute thiamine deficiency. If not treated by administration of thiamine within a few hours, the neurological effects can include permanent nystagmus and permanent loss of short term memory. This Wernicke-Korsakoff syndrome of course is most often seen in the West in patients with alcohol dependency - but can also occur during following starvation during the refeeding phase. A fascinating example is as mentioned, Dr James Scott who was lost in the Himalayas for around 40 days and wrote up his experience in the Annals of Internal Medicine. He started off with a higher BMI than the boy'.

Please see many references on the syndrome: e.g https://www.schn.health.nsw.gov.au/_polici…/pdf/2013-7036.pdf & https://www.nice.org.uk/guidance/cg32/chapter/1-Guidance… – see point 1.4.6. '

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