Unintentional Weight Loss

Dr. Steven Koprowski presented a case of an older gentleman with cirrhosis, hemochromatosis, osteoporosis with compression fractures and recent admission for 100 lb unintentional weight loss who presented with acute onset dyspnea and hypoxia in the setting of somnolence with escalating opiate doses. He was ultimately diagnosed with a multifocal aspiration PNA. In addition, work up revealed an extremely elevated TTG with biopsy proven celiac disease as the etiology of his unintentional weight loss.

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Learning Points:

Clinically significant weight loss is >5% of usual body weight over 6-12 months.

The DDx is expansive, thus a careful history and physical exam can help guide your diagnostic testing. It is important to document amount and pattern of weight loss, associated symptoms (GI symptoms, malabsorption, malignancy signs and symptoms, psych), med list, and functional factors (dysphagia, poor dentition, cognitive issues).

The major causes of unintentional weight loss include:

  • Malignancy (GI, lung, lymphoma, renal, prostate cancers)
  • GI diseases (IBD, peptic ulcer disease, celiac disease)
  • Psychiatric disorders
  • Endocrinopathies
  • Infectious diseases (HIV, TB, viral hepatitis, chronic fungal, bacterial or parasitic infections)
  • Advanced chronic disease (heart failure, COPD, renal failure)
  • Neurologic diseases (CVA, dementia, ALS)
  • Medications/substances (alcohol, cocaine, amphetamines, tobacco, herbals)
  • Rheumatologic diseases (RA, vasculitis)

Diagnostic testing is often based on history and physical and can include CBC with diff, CMP, hemoglobin A1c, calcium, UA, TSH, ESR/CRP, HIV, hep C, CXR, and age appropriate cancer screening. Advanced diagnostics (i.e. EGD, colonoscopy, CT imaging is often guided by clinical suspicion).