Systemic fragility in non-geriatric adults

Specialty: General.

• adult physical vulnerability
• reduced physiological reserve
• pre-cachexia state
• propensity to systemic collapse

Why it occurs

• Active multisystem chronic inflammatory disease (systemic lupus erythematosus, rheumatoid arthritis or uncontrolled inflammatory bowel disease, which decrease the functional reserve of multiple organs)
• HIV infection in the intermediate-advanced phase with persistent viral replication and low-grade immune dysfunction
• Long-term severe substance abuse disorder (alcoholism, use of opiates or psychostimulants, which destroy the intestinal barrier and cause malnutrition and neurotoxicity)
• Moderate to severe chronic organ failure (cardiac, renal or hepatic, which keeps the patient in a precarious hemodynamic and metabolic balance)
• Long-term severe post-traumatic stress disorder with extreme neuroendocrine dysregulation.

Initial workup

Complete blood count, ESR, CRP, albumin, prealbumin, serum immunoglobulin profile, CD4/CD8 lymphocyte subpopulation count, creatinine clearance, echocardiogram, and manual dynamometry (grip strength).

Standard management

• Nutritional supplements with high content of leucine and whey proteins — to promote muscle and cellular anabolism
• Vitamin D3 combined with Calcium — 2000 IU and 500 mg per day orally for bone and muscle support
• Optimized treatment of the underlying inflammatory or infectious disease under the direction of the corresponding specialist.