Progressive general wasting with slight weight loss

Specialty: General.

• incipient physical consumption
• subacute general deterioration with slight weight loss
• mild functional decline

Why it occurs

• Type 2 diabetes mellitus of recent onset or progressive decompensation (massive glycosuria with low-grade urinary caloric loss that induces mild muscle and fat wasting)
• Slow course primary hyperparathyroidism (elevated PTH secretion causing mild hypercalcemia, secondary anorexia and generalized weakness)
• Subclinical intestinal malabsorption (celiac sprue in adults, mild exocrine pancreatic insufficiency or severe undiagnosed food intolerances)
• Chronic renal failure in stage IIIa or IIIb with incipient mild uremic syndrome (accumulation of toxins that alter taste sensitivity and depress muscle anabolism)
• Early gastrointestinal neoplasms with an insidious course (early gastric cancer or bleeding colonic polyps that cause iron deficiency anemia and mild wasting).

Initial workup

Complete blood count, extensive metabolic panel (glucose, urea, creatinine, serum electrolytes with serum calcium and phosphorus), serum albumin and prealbumin, IgA antitransglutaminase antibodies, complete abdominal ultrasound, and fecal occult blood in three serial samples.

Standard management

• Nutritional supplements enriched with proteins and vitamins orally — a bottle between meals to stop mild consumption
• Treat the underlying cause: Metformin or other oral hypoglycemic agents under medical supervision if the cause is decompensated diabetes mellitus
• Cholecalciferol (Vitamin D3, 1000 IU daily orally for general metabolic support).