Autopsy Findings of Starvation

Starvation is the result of deprivation of the regular and constant supply of food, a source of energy, that is required for our health and life. Terms like malnutrition, Cachexia, and emaciation are often used along with starvation. A person can survive up to 10-12 days without water and food and if food alone is withdrawn, then death may occur in 6-8 weeks or sometimes even more.

There are mainly two types of starvation- Acute and Chronic. In Acute starvation water and food supply are withheld completely and suddenly. In chronic starvation, there is a gradual deficiency in the supply of food. Factors like age, sex, exposure to cold, condition of body affects death due to starvation. An adult’s food requirement is a minimum of about 2000 calories (if not performing any activity). When 40% of the original body weight is lost, life is at risk.

Starvation will result in loss of well-being, hunger, fatigue, edema of the face, emaciation, hypothermia, polyuria, cachexia, extreme lethargy, mental retardation, constipation, diarrhea and reduced immunity. The clinical features of wet type starvation known as Kwashiorkor and dry type known as Marasmus will be different.  

Postmortem Findings of Starvation

External Autopsy Findings

• Rigor mortis sets in and disappears early.
• The skin becomes stretched and wrinkled and appears to be pale, lustrous, and semi-translucent because of the loss of subcutaneous fat.
• Skin infections might be seen. There may be infected red/pressure sores over dependant parts. Because the entire body shrinks, the head appears deceptively larger than the trunk.
• The limbs are almost skeletal due to the loss of fat and muscle.
• As the orbital fat and facial muscles are also lost, the eyes appear to be sunken and the cheekbone becomes prominent, with sunken cheeks and defined jawline.
• In the case of wet type of starvation marked edema of the face, trunk, and limbs with ascites and pleural effusion can be seen.
• The loss of muscle and fat happens because the body burns the fat reserves during starving and when starvation is prolonged, the body uses the proteins within the muscle tissues as a source of fuel which eventually results in loss of muscle mass. 
• Ribs will appear to be prominent with concavities of the intercostal spaces and sunken supraclavicular fossae.
• Nails becomes ridged and brittle, the tongue gets dried and thickly coated, hair becomes dry, lusterless, and brittle, or even hypopigmented.
• In the case of children or infants, it is necessary to record the body measurements like mid-arm circumference, head diameter, crown-rump, and weight to compare with standard pediatric percentile growth charts.

Internal Autopsy Findings

• The major feature is the atrophy of the organs except for the brain with the reduction in their sizes.
• Bones may show features of demineralization and osteomalacia. In children, the bones might show rickets, spinal curvature, or dental defects.
• Adipose tissue is lost from the omentum, mesentery, and perirenal fat stores.
• The gall bladder will dissent and the gut will be empty with gases filled. The wall is contracted and translucent from the stomach to the colon.
• Faecoliths are usually present and may ulcerate the intestinal linings.
• As the lipochrome increases the muscles will appear to be dark and atrophied.
• Lungs when cut will drain very little blood.
• The heart will also be empty and small from brown atrophy.
• The walls of the intestine might appear like tissue paper.
• The liver might also shoe necrosis due to protein deficiency.
• The urinary bladder will be empty.

Conclusion

Death due to starvation is a rare cause of death. But it may be of major medicolegal importance if the death results from deliberate withholding of food. In such a case the forensic pathologist and the medical examiner not only clarifies about the cause of death but also give an expert opinion on the degree and duration of starvation.

Starvation may be a manifestation of self-neglect or a criminal act it can be a result of suicide or homicide or accidental. An autopsy is necessary to understand that the death had occurred due to starvation and not due to other diseases or medical conditions.

If marked loss of weight and especially the absence of fat are found at autopsy, and there is no evidence of disease, a diagnosis of death due to starvation can be made.