Ketoacidose (noncompensated) with heavy growing complications.

It happens in 2-5% of the patients, usually, during the first fast. It accompanied by vertigo, sickness, vomiting, general weakness. In this case alkaline mineral water should be prescribed or sodium hydrocarbonate (2-3 g every 2-3 hours). If there is no effect during 12-24 hours fasting should be dropped. Sodium hydrocarbonate must be taken, oxygen inhalations and re-feeding nutrition. But if the patient is strongly willing to continue fasting, the fasting could be continued in 2-3 days (fractional fasting method).

Ortostatical collapse (syncope)

More often this undergo in patients suffering from hypotonia (AP is under 90/60 mm). If it occurs, patient should be in horizontal position with his legs up, flow of fresh air should be ensured, a tampon with liquid ammonia is under his nose, (in rare cases inject caffeine or cordiamine). If syncope repeats fasting should be dropped. As prophylactic measures it is recommended to avoid sharp movements, getting up from the bed quickly.

Malignant arrthytmias, unstable angina

Is very rare to happen and show as extracistolia. In its base lays hypocaligistia, caused by ketoacidose and breach of activity of K+-Na+-AT Phase. If the patients complains on tachycardia, aches in the heart area, urgent electrocardiographia should be hold. Preparations of potassium (panangin, asparkam, etc) and Я-adrenoblocks (obzidan) should be prescribed. If there is no positive result within 12-24 hours fasting should be stopped. Prophylactic measures consist of do not alowing persons that suffers from breach of cardiac rhythm in anamnes to go long-term fast. In this case fractional fasting method could be implemented (1-2-3 days of fasting).

Kidney and bilious colic.

Could be at patient with nephro-stone and gall-stone diseases. If colic begin, fasting should be dropped, spasmolitics and analgetics in normal therapeutic doses should be prescribed. Prophylactic measures: adequate drinking regimen in the process of fasting (no less then 1- 1,5 l per day).

Acute erosive-ulcerous changes of gastroduodenal zone.

Happens rarely (in 2-5 %). In case of stable epigastral aches, heart burning, eructation, phibrogastroduodenoscopy should be hold. Presence of acute erosive-ulcerous changes of mucous membrane of the stomach and duodenum is an indication to discontinue fast. Antacides should be prescribed (Almagel, Vikalin) or Venter (Surralfat), As usual, epitelisation of the ulcer and erosion happens within 10-14 days of fasting.

Convulsions.

Is very rare to happen, usually at long terms of fasting (over 20-30 days). Tonic convulsion of calf muscles, finger and chewing muscles are developing. The reason is water-electrolit shifts. For internal use 1% solution of sodium chloride 20-30 ml 4-5 times per day.

Syndrome of "food overload".

Occurs during first 3-5 days of refeeding period if prescribed regimen of nutrition (overeating) and ration are broken. It causes sickness, vomiting, overloading in epigastry, disorder with stool. It is necessary to lavage the stomach, to give salted laxative, and to recommend food abstinence for 1-2 days (full fasting). Prophylactic measures: keeping the dietetic regimen of the refeeding period of fasting therapy.

"Salt" oedema.

Happens during refeeding period if the diet is not kept (use of salt, herring, butter, cheese, etc). It causes oedema under eyes, headache, weakness, increase of mass of the body (up to 1,5-2 kg). Oedema passes independently within 1-3 days if the diet does not contains salt. Diuretics (hypotiazide, etc) or laxatives help to vanish oedema. Prophylactic: absolute exclusion of salt and saltcontaining products for all rehabilitation period (3-4 weeks).

Indications for discontinuance of fasting:

• categorical rejection of patients to continue fast
• heavy process of ketoacidose, that cannot be treated by bi-carbonates
• repeated ortostatical scollapse
• stable disorder of cardiac rhythm
• symptoms of growing insufficiency of circulation of the blood
• stable sinusoid tachicardia (110-120 beats /min and more)
• atacks of kidney and bilious colic
• marked bradicardia (50 beats/min and less)
• increase of content in the blood AlAT, AsAT and/or direct bilirubin 2 times beyond the norm
• acute erosive-ulcerous changes of gastroduodenal area.

Scietific abstracts:

Acute kidney failure as a complication of fasting therapy
Schweiz Med Wochenschr. 1977 Jul 23;107(29):1025-8.
[Article in German]
Zurcher HU, Meier HR, Huber M, Lammli J, Wick A, Binswanger U.
Acute urate nephropathy during starvation for weight reduction has been observed in 2 patients. Under these conditions ketoacidosis causes impaired renal uric acid excretion and hyperuricemia. Uricosuric agents or sudden intake of normal calorie diet induces massive uricosuria and kidney damage. Uricosuric agents should be avoided and steps taken to promote abundant diuresis, while allopurinol should be prescribed.


Fasting: the history, pathophysiology and complications.
Kerndt PR, Naughton JL, Driscoll CE, Loxterkamp DA.

West J Med. 1982 Nov;137(5):379-99.