First week - after 15 – 18 days
Stages of total fasting
The first week
fasting generally well supported, as long as water intake is sufficient
hunger pangs and stomach cramps disappear after the 2nd – 3rd day
After 15 – 18 days
the hunger strikers suffers from dizziness and feeling faint
severe ataxia
standing up may become difficult to impossible
bradycardia
orthostatic hypotension
lightheadedness [3] or inversely mental sluggishness
sensation of cold [4]
general sensation of weakness
fits of hiccoughs
loss of the sensation of thirst [5]
At the end of the first month, symptoms may be severe enough to warrant hospitalization. Hydration needs to be particularly monitored. Too much supplement of NaCl may lead to hypokalemia.
Between 35 – 42 days
troubles of ocular mobility due to progressive paralysis of the oculomotor muscles:
uncontrollable nystagmus
diplopia
extremely unpleasant sensations of vertigo
uncontrollable vomiting
extremely difficult to swallow water
converging strabismus
This has been described as the most unpleasant phase by those who have survived prolonged fasting, and is the phase most dreaded by potential hunger strikers.
One week after the « ocular » phase
once paralysis of the oculomotor muscles is total ⇒ nystagmus ceases and with it all associated problems (vertigo, vomiting…)
From ~ 42 days onward
progressive asthenia
torpitude (sluggishness)
increasiningly confused state
concentration becomes difficult or impossible
somnolent state
anosognosia (i.e. failure to recognize the seriousness of the situation)
indifference to surroundings
incoherence
At this stage, it is impossible to evaluate intellectual functions and to determine what the hunger striker’s state of mind is. Any decision made to ascertain what the hunger striker wants the medical staff to do, at and after this stage, will have to have been made beforehand!
Further even more serious complications follow:
loss of hearing
blindness [6]
diverse forms of hemorrhage: gingival, gastro-intestinal, esophageal
the body shuts down progressively: extreme bradycardia, Cheyne-Stokes respiration, all metabolic activity diminishes…
Between 45 – 75 days
death occurs from cardiovascular collapse and/or severe arrhythmias [7]
[3] Due to electrolyte imbalance. See Peel, M. footnote 7. (Peel M. Hunger Strikes: Understanding the underlying physiology will help doctors provide proper advice. BMJ 1997; 315: 829-30.)
[4] Blood thyroxine levels remain stable throughout fasting, but tri-iodothyronine is converted rapidly into an inactive metabolite, thereby reducing thyroid function, and base metabolic rate. Ibid, Peel, M.
[5] Ideally, water should be supplemented with 1.5 g of NaCl per day (one half-teaspoon salt)
[6] From hemorrhage in the retina.
[7] Mainly due to acute depletion of thiamine (Vitamin B1)=> systolic heart arrest.