Comas and Weight Loss.

Factual Questions
1

A little while ago, I was having an interesting discussion with my doctor. I told him, as a child and young man, I was always complaining I was too thin. Now, that I am a little bit older, and have gained a little weight, I am complaining about that. Actually, he told me, having a little extra weight may not be that bad. If you go into a coma for a short while, your body will live off your stored fat. Thus if you’re skinny, you will essentially die from being in a coma too long.

This got me to thinking. Why do you always lose weight in a coma? I mean, they give you nutrients in your IV drip, don’t they? And if worst comes to worst, they can always attach a feeding tube to your stomach, no? So why do you always lose weight?

(Quick side note: I also heard this story when I was still a little kid about overweight Hollywood stars. When they needed to lose weight quickly for a film or something, they had themselves put in a drug-induced coma, and thus lost the weight. Again, I ask, Why?)

:slight_smile:

2

Two thoughts:

  1. Just how likely do you think it is that you’ll find yourself lapsing into a coma?? Unless you have a medical condition which would make it far more likely than normal, it seems a pretty unlikely scenario, and thus a pretty silly reason to carry extra weight.

  2. Regarding the story about actors and drug-induced comas: I find this incredibly unlikely. See if you can find even a single reliable citation on it.

3

  1. You’re probably right. But realize, it was the doctor who brought it up, not me.

  2. I don’t know, I guess I could do a search. But realize, I heard this when I was still a kid. So it is very hard to check my data on this one.

4

Well, it’s not clear just how skinny or fat you are, or if your doctor might feel that you have a psychological issue about body image and weight (in which case, he might be just trying to come up with reasons to convince you to not be thin as a rail). Barring that, it just sounds like very strange advice.

2 minutes of Googling suggests that a medically-induced coma is a very serious thing, and can lead to grave side effects. This certainly suggests that no reputable doctor would do this for such a spurious reason.

5

Been there, done that and I actually gained 10 lbs. :slight_smile:

6

It sounds counterintuitive that you loose weight just by lying around when the key to normal weight loss is extra movement.

On the other hand, some studies have shown that during sleep, calories are burned better than during day (at rest, of course), because of different hormones.

I also have heard that the liquid food stuff they give you in hospitals isn’t “real food” (nothing to chew on, only the bare nutrients, but not all the other stuff that’s in real food) and therefore, people on liquid food will loose weight (with or without coma) because their body can’t get full use from the stuff.

I don’t know how serious that is, however, considering that most people in hospitals are sick and therefore, the disease(s) they have might prevent proper digestion of all nutrients in the food, despite liquidity or not.

I haven’t heard of serious studies comparing healthy people on a liquid diet vs. normal food, if they loose weight or not.

I also don’t know how liquid food is assembled: is just some glucose, salt and minerals mixed with water, or do they puree a meal (like they puree fruits to make smoothies) and put that in a bag?

The only people I’ve read about bulking up weight on purpose because of digestion (and not weight class in competition) are people who plan to climb the Mt. Everest or similar heights: up in the death zone, the body doesn’t have enough energy to digest food in your stomach (and people loose most of their appetite), so it starts digesting itself, so people need extra fat and muscle for the hours in the death zone.

But I assume that’s not what you’re planing on?

Is some operation scheduled where you are not going to be able to eat normally afterwards (throat or stomach) so some fat would be beneficial?

7

No, I am not planning on having an operation. Like I said, it was just a casual conversation I had with my doctor. Was that your question:)?

8

I am. I’m scheduled for surgery tomorrow and have been told to expect to stay in for about a week. It’s non weight-loss related abdominal surgery, so I will be on liquids for a few days.

I’m going to weigh myself beforehand and again when I get back to see what happens. The only thing that might throw it off is that I’ve been losing weight for about two years or so (slow and steady improvements to diet and adding exercise have shed ~70lbs.). I’ve worked up to 1.5 hours of heavy cardio 5 days a week and weights 3 days a week, so the sudden shift from exercising to complete sedentaryness might muck things up a bit. I also can’t get back on the exercise horse for four weeks, so the weight gain/loss curve should be interesting.

9

Regarding your first question, I suspect people in comas lose weight because they lose muscle mass, and muscle weighs more than fat and fluid.

As far as the drug-induced coma for weight loss, I seem to remember that one of the characters in Valley of the Dolls went to Europe for a “sleep cure” and returned fit and healthy and supposedly cured of both her obesity and her drug addiction. I’ve never heard of a real-life application, though.

10

My dad, a chronically skinny fellow at 140 lbs and 6’, didn’t lose weight from being in a coma and then bedridden for years. Well, maybe he did in the early days when he was only on an IV, but he was fed through a tube for over a year after his head injury and got fatter than he’s ever been during that time (up to 190 lbs), and he’s had a little gut he never had before ever since. The shit they feed you in hospitals is unbelievable.

But yes, it is best to have a little bit extra bodyweight in case of emergency. I’m also very thin and I worry what will happen if I have a medical disaster - I can’t imagine losing 20 lbs the way some people do when they get sick. On the other hand, most of the people who lose a ton of weight due to medical events seem to have plenty of extra weight to lose.

11

(ICU nurse here.)

When a person is comatose and expected to remain so for any length of time, even just a few days, the standard of care is to initiate artificial nutrition within a day or two. Sick people need nutrition in order to heal. The hospital’s dietitian calculates exactly how many calories the patient needs in addition to the proportion of fat, protein, carbs, etc.

Ideally, the patient is fed via a tube leading to the stomach or small intestine. There are various premixed formulas tailored to the patient’s condition: there are formulas for diabetics, people with kidney problems, lung problems, etc. Additional protein supplements may be ordered. Vitamins and minerals are included in these formulas.

If the patient can’t be fed through the GI tract, say if there is a problem such as a bowel obstruction, nutrition will be given IV.

Even patients who are massively obese will be fed with the goal of maintaining their current weight. When you are critically ill is not the time to be on a diet. If you’re sick enough to be in a coma (medically induced or not), depriving you of nutrition will only make you sicker.

Many if not most patients who are comatose will be kept sedated with Propofol, the “Michael Jackson” drug. Propofol has a very high fat content, so the dietitian considers the fat/calories from the Propofol when determining the patient’s nutritional needs.

Usually, comatose patients will gain weight, but this is “water weight”. They swell up like toads. Even with the use of diuretics, this shifting of fluids is almost inevitable. This is why we weigh patients daily and calculate exactly what goes in vs what goes out. We also monitor labs at least daily to check the levels of potassium, sodium, and various other things.

When a patient recovers after a long period of being comatose, muscle wasting will have occurred. He’ll be profoundly weak and require extensive physical and occupational therapy to resume doing the most basic activities. His skin will be wrinkly from being stretched like a balloon and back again.

No, patients don’t lose much weight from being in a coma, assuming the medical team is at all competent. Unless you have an advance directive saying you do not want a feeding tube and do not want IV nutrition, you will be fed. You may not lose an ounce, but the longer you’re in that condition, the more likely you’ll be to look like crap.

12

I think I’m going to remodel our kitchen with the counter-intuitiveness of that statement. Or do you work for one of those volcano or dark castle “evil” hospitals that have problems when coma patients finally wake up?

13

This is why I come here. Sometimes I just love the dope.

14

[hijack]
blinkie !!! You’re still alive and with us! I haven’t seen a post from you for a quite a while. I’ve been wondering what became of you.
[/hijack]

15

To add a little to syncope’s post: it depends on why the person is in a coma.

For example, the first 5 to 12 days of coma from brain injury can be associated with a doubling of basal energy expenditure. But after that initial phase calorie requirements decrease. Coma induced by drugs like barbiturates may cause a significant decrease in caloric needs; comas associated with fevers/infections or seizures may require many more calories to avoid body mass loss. That dietician needs to account for those factors.

Yes, much of the weight loss in the case of undernutrition relative to needs will be muscle mass loss. Overshoot and gain fat.

16

As to your doctor’s possible point. If you were previously clinically underweight, then you may be better off being higher end of normal, or even borderline “overweight” than there. Maybe not coma, but any serious illness. A little energy reserves can be useful, and those high normal, BMI’s 22 to 25ish, have the lowest mortality rates, lower than those who are thin. (Some studies have shown some benefit from being slightly higher BMI than that but a recent large pooled study finds that 20 to 24.9 is associated with the least mortality. Still 18.5 to 20 is “normal” yet associated with slightly higher risk of death, and underweight, less than 18.5, is a significant risk marker. Better solid side of normal.)

17

This is an interesting question. I think, as your body don’t move the metabolism process start to slow down and the hormone plays an important role to lose the weight. For more details you can see

What is metabolism?

18

There are many reasons why critically ill patients benefit from sedation. DSeid’s example of patients with brain injuries is excellent: sedation is one of the tools we use to save the lives of such people.

Another example is a patient with severe lung disease who “fights” the ventilator. Struggling to breathe/cough, in extreme cases, can easily cause the patient to become exhausted. Imagine not being able to breathe, then having to try to breathe through a straw while having a panic attack. If you can’t relax, you will turn gray and die. We have to be able to get the oxygen into you.

Most any patient who is on death’s doorstep benefits from resting, while we do as much of the work for him as we can. This is the whole point of life support.

Ideally, all patients would be able to be on a ventilator without sedation and yet remain calm and have stable vital signs. In the real world where I live, this is often not the case.

Also important is the fact that being on a mechanical ventilator is extremely uncomfortable, even unbearable, for most patients without sedation. Even comatose patients (unless they are very close to brain death) are visibly uncomfortable without adequate sedation/pain control. I don’t like to torture people.

Our goal is to use the minimum amount of sedation to achieve the desired results and to wean the patient off the sedation at the earliest opportunity. Unless the patient is very unstable, he’s given a “sedation vacation” at least once per shift. Propofol is ideal for this because it has such a short half-life: you can wake the patient up in minutes, and put him back under (if necessary) in seconds.

There is nothing better than having a comatose patient wake up, really wake up, and be okay again. That is why I do what I do. I’ve been working my ass off for many years to save as many as I can. We can’t save them all. We can’t even save most of them, and honestly there have been many times when I’ve wished I could trade my own life to save a patient I could not save.

19

To piggyback off syncope’s comments, I had a brother-in-law who was in the ICU for months due to liver failure. For the first part of his hospitalization, he was (to the best of my medical understanding and observation), comatose. He finally did regain consciousness when his mother and I were there, and struggled against the ventilator for a bit, but we got him calmed down and to apparently understand who we were and where he was (hand squeezes to answer yes/no or multiple choice questions). I don’t know if they had used sedation before that, but afterwards he did require sedation to be able to rest and tolerate the ventilator and feeding tube. There were times when apparently it wasn’t sufficient, as at least once when I was visiting, he was not noticeably conscious, but was struggling a bit and had mild restraints on his arms to keep the IV/g-tube/etc. in.

Side note: I found out later on, well after he was out of the hospital and rehabilitation center, that he didn’t remember waking up and seeing his mom and I. I can’t say I’m surprised, what with everything he went through. So I got the privilege of telling him the story of how his mom and I got to be the first people to see him regain consciousness, and how that gave the family hope that he could pull through.

20

I didn’t lose weight. In fact, the family said that at one point I swelled up like a toad because they put me on steroids. I had a feeding tube also. But after I got home I lost quite a bit of weight and was weak as a kitten.