Hunger strikes, or volitional fasting as a form of protest, are dangerous clinical situations among patients in carceral settings, fraught with clinical, ethical, and legal challenges balancing patient safety and autonomy. This presentation will synthesize historical data as well as medical literature documenting natural history, evaluation (including clinical biomarkers and factors associated with starvation-related outcomes), and management of starvation and postfasting sequelae like refeeding syndrome to illuminate evidence-based best practices.

Educational Objectives

• Examine the physiologic basis and natural history of starvation, including end-organ effects and reversibility
• Identify patient-, practice-, and system-level clinical factors influencing adverse patient outcomes in starvation
• Appraise evaluation and monitoring parameters for management of starvation, including refeeding syndrome

Level:Intermediate