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ULY CLINIC

16 Septemba 2025, 03:15:58

Polyphagia (Hyperphagia)

Polyphagia refers to excessive or voracious eating. It may be persistent or intermittent and commonly arises from endocrine disorders, psychological conditions, or certain medications. Depending on the underlying cause, polyphagia may lead to weight gain or, paradoxically, weight loss (e.g., in uncontrolled diabetes mellitus).

Pathophysiology

Polyphagia results from dysregulation of appetite and satiety signals:

Diabetes mellitus: Insufficient insulin prevents glucose utilization, causing cellular starvation and compensatory excessive eating.
Endocrine disorders: Hyperthyroidism or hormone therapy may increase metabolic demand or appetite.
Psychological conditions: Anxiety, stress, or eating disorders like bulimia may trigger compulsive eating.
Premenstrual syndrome (PMS): Hormonal fluctuations induce transient increases in appetite and food cravings.
Drug-induced: Corticosteroids, cyproheptadine, and some hormone supplements stimulate appetite.

Emergency Interventions

Polyphagia is usually not an acute emergency but may contribute to metabolic decompensation in certain cases (e.g., diabetes mellitus):

Monitor blood glucose and hydration status.
Address electrolyte imbalances if polyuria or vomiting occurs.
Evaluate for nutritional deficiencies or excesses.
In severe cases (bulimia or other eating disorders), assess for risk of self-induced harm or metabolic complications.

History and Physical Examination

Dietary and Behavioral Assessment

Ask the patient to recall all food and fluid intake in the past 24 hours (and optionally the previous 2 days).
Note meal frequency, portion sizes, and types of foods.
Determine if overeating alternates with periods of anorexia.
Ask if the patient eats due to true hunger or availability of food.
Assess for postprandial vomiting, headaches, or GI symptoms.

Associated Symptoms

Weight changes, fatigue, irritability, nervousness, excitability.
Heat intolerance, palpitations, dizziness, diarrhea, or increased thirst/urination.

Physical Examination

Record weight and note patient’s reaction.
Inspect skin for dryness, poor turgor, or other dermatologic signs.
Palpate the thyroid for enlargement or nodules.

Medication History

Include laxatives, enemas, corticosteroids, cyproheptadine, and hormone supplements.

Medical Causes

Cause	Clinical Features	Notes
Anxiety	Restlessness, irritability, sleeplessness, tachycardia, GI distress, palpitations, urinary/sexual dysfunction	Mild to moderate anxiety may trigger polyphagia
Bulimia	Alternating overeating and self-induced vomiting, low weight, depression, low self-esteem	Most common in women 18–29; fear of obesity is prominent
Diabetes mellitus	Polyphagia, polyuria, polydipsia, weight loss, fatigue, dehydration	Hyperglycemia-induced cellular starvation
Premenstrual syndrome (PMS)	Food cravings, binge eating, abdominal bloating, depression, insomnia, headache, neurologic symptoms	Weight gain is usually temporary; associated behavioral changes common
Drug-induced	Increased appetite with corticosteroids, cyproheptadine, hormone supplements	Monitor for rapid weight gain

Other Considerations

Assess for psychological triggers such as stress, depression, or situational factors.
Consider endocrine disorders (hyperthyroidism, growth hormone excess).

Special Considerations

Provide emotional support and help the patient understand the underlying cause.
Refer to psychological counseling for patients and families as needed.
Monitor for complications of overeating such as obesity, metabolic syndrome, or electrolyte disturbances.

Patient Counseling

Encourage nutritional counseling to promote balanced eating habits.
Provide support for personal and family counseling if polyphagia is stress- or anxiety-related.
Educate about disease processes, behavioral triggers, and importance of follow-up.

Pediatric Pointers

In children, polyphagia often indicates juvenile diabetes mellitus.
Infants (6–18 months) may develop polyphagia due to malabsorptive disorders (e.g., celiac disease).
Occasional polyphagia may be normal during growth spurts.

References

Berkowitz, C. D. Berkowitz’s Pediatrics: A Primary Care Approach (4th ed.). USA: American Academy of Pediatrics; 2012.
Buttaro, T. M., Tybulski, J., Bailey, P. P., Sandberg-Cook, J. Primary Care: A Collaborative Practice (pp. 444–447). St. Louis, MO: Mosby Elsevier; 2008.
Colyar, M. R. Well-Child Assessment for Primary Care Providers. Philadelphia, PA: F.A. Davis; 2003.
Lehne, R. A. Pharmacology for Nursing Care (7th ed.). St. Louis, MO: Saunders Elsevier; 2010.
McCance, K. L., Huether, S. E., Brashers, V. L., Rote, N. S. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Maryland Heights, MO: Mosby Elsevier; 2010.
Sommers, M. S., Brunner, L. S. Pocket Diseases. Philadelphia, PA: F.A. Davis; 2012.