Original Article

Veterinary Pathology
2016, Vol. 53(5) 1087-1094
Circumstances, Descriptive Characteristics, ª The Author(s) 2015
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and Pathologic Findings in Dogs Suspected DOI: 10.1177/0300985815575049
vet.sagepub.com
of Starving

J. A. Gerdin1, S. P. McDonough1, R. Reisman2, and J. Scarlett3

Abstract
The authors reviewed the case circumstances, population characteristics, gross, and histopathologic findings in 40 cases of
emaciated dogs with a suspected diagnosis of starvation. The dogs’ estimated age ranged from 3 months to geriatric. Nineteen
breeds were represented, including small-breed (n ¼ 11), large-breed (n ¼ 13), and pit bull–type (n ¼ 16) dogs. The median body
condition score was 1 out of 9 (Purina scale). Various diseases were identified as the cause of death in 7 dogs, while the cause of
death in the other 33 dogs was starvation due to exogenous causes (SEC). Circumstances associated exclusively with SEC
included being found in a vacated residence and death during temperature extremes or severe weather. Dogs with SEC did not
differ significantly from diseased dogs in body condition score, sex, neuter status, or breed category (small, large, or pit bull type).
Gross findings associated exclusively with SEC included severe hair matting and traumatic injuries. Diseased dogs had an empty
stomach significantly more often than SEC dogs, which frequently had food and/or foreign material in the stomach. In 5 of the 7
cases where disease was the cause of death, disease involved the gastrointestinal tract. Gross and histopathologic changes
commonly found in SEC and diseased dogs included the following: gross loss of muscle mass and absence of subcuticular fat;
serous atrophy of omental, perirenal, epicardial, and bone marrow fat; atrophy of the liver, skin, thyroid gland, and testicle; gastric
mucosal petechiae and ecchymoses; melena; and splenic hemosiderophages.

Keywords
dogs, malnutrition, starvation, undernutrition, forensic veterinary pathology, animal abuse and neglect

Diagnostic laboratories are increasingly presented with cases of of the body. Examples of starvation due to exogenous circum-
suspected neglect, in which an animal may have been deprived stances (SEC) include inability to access food provided
of adequate food, water, shelter, or care.27 In many cases of (eg, snowdrifts, hostile herd mates), inappropriate diets, and
suspected neglect, the animal is emaciated, meaning that it has inadequate quality or quantity of food. Some endogenous dis-
a severe and diffuse loss of fat and skeletal muscle. When an eases can also result in starvation culminating in emaciation
emaciated animal is submitted for necropsy, typically the cause (eg, exocrine pancreatic insufficiency). Some disease-
of emaciation is sought, and a negligent or willful deprivation associated clinical signs (eg, regurgitation, vomiting) and
of food is suspected. symptoms (eg, nausea, changes in taste and smell) may occur
Emaciation is the corporeal result of 2 different chronic
pathophysiologic mechanisms: cachexia and starvation.
Cachexia is multifactorial, primarily cytokine-mediated wast- 1
Department of Biomedical Sciences, Section of Anatomic Pathology, College
ing that occurs in conjunction with endogenous disease, such of Veterinary Medicine at Cornell University, Ithaca, NY, USA
as cancer, organ failure, and some infections. Cachexia is 2
ASPCA Animal Hospital, American Society for the Prevention of Cruelty to
characterized by voluntary reduction in caloric intake (anor- Animals, New York, NY, USA
3
exia), increased protein catabolism, and a disproportionate Department of Population Medicine and Diagnostic Sciences, College of
Veterinary Medicine, Cornell University, Ithaca, NY, USA
loss of lean body mass compared to adipose, and it is refrac-
tory to nutritional support.11,14,29,31 Supplemental material for this article is available on the Veterinary Pathology
In contrast, starvation is characterized by an involuntary website at http://vet.sagepub.com/supplemental.
reduction in caloric intake, decreased basal metabolic rate, and
relative sparing of lean body mass until fat stores are depleted, Corresponding Author:
J. A. Gerdin, Department of Biomedical Sciences, Section of Anatomic
and it is correctable with nutritional support.12,41 Starvation Pathology, College of Veterinary Medicine at Cornell University, S2 120
typically occurs due to exogenous circumstances—adverse Schurman Hall, Ithaca, NY 14853, USA.
conditions that are not discoverable through an examination Email: jag56@cornell.edu
1088 Veterinary Pathology 53(5)

in conjunction with either mechanism—cachexia or starvation. as follows: young puppies (0–3 months), older puppies
Necropsy should reveal endogenous causes of emaciation, (3–6 months), young adult dogs (6 months–1.5 years), adult
whereas the reasons behind SEC are revealed only through dogs (1.5–6 years), and geriatric dogs (6 years). Age was
an inquiry into an animal’s environment and diet. classified as young adult (<1.5 years) or older adult (>1.5
Despite the fact that emaciation is one of the most common years) for statistical purposes, as insufficient numbers of dogs
reasons for law enforcement officers to seize dogs,36 reports of were present for comparisons using more narrow age ranges.
gross and histopathologic findings in emaciated dogs are rela- Dogs were categorized into breeds based on appearance: small
tively uncommon and have focused on dogs with SEC.30,39 Our breeds, large breeds, and pit bull–type breeds, including the
purpose was to document and summarize the gross and histo- Staffordshire Bull Terrier, American Staffordshire Terrier, and
pathologic findings in emaciated dogs suspected of starving American pit bull terrier.
and to characterize differences, if any, in the circumstances, The BCS was determined using the Purina system21 and,
descriptive characteristics (age, breed, etc), gross findings, and with 1 exception, was determined by 1 author (J.A.G.) on the
histopathologic findings between dogs with endogenous dis- basis of either personal inspection (2 cases) or photos of the
ease and those with SEC. body immediately prior to necropsy (39 cases). In the case
where photos were unavailable, the BCS assigned by the veter-
inarian who conducted the necropsy was used. A BCS of 1 was
Material and Methods differentiated from a BCS of 2 based on the Purina BCS guide-
line criteria of ‘‘minimal loss of muscle’’ for a BCS of 2 and
Case Selection ‘‘obvious loss of muscle mass’’ for a BCS of 1.21
Between January 1, 2007, and December 31, 2013, a retrospec- Postmortem condition of the bodies varied from euthanasia
tive study of emaciated dogs or tissues from emaciated dogs with a brief postmortem interval resulting in minimal autolysis
submitted by or on behalf of a humane agency with the suspi- and artifacts to moderate to severe autolysis and decomposition
cion of starvation was conducted at the New York State Animal with an unknown postmortem interval. Freeze artifact was
Health Diagnostic Center at the Cornell University College of present in many cases, due to either the body being found in
Veterinary Medicine (CU-AHDC). Dogs were excluded if the subfreezing temperatures or intentional postmortem freezing
body was not emaciated (body condition score [BCS] >2) or in semicontrolled environment (freezer). One case had mild
if the degree of autolysis, decomposition, and/or artifacts was scavenging, limited to the extremities. The condition of the
severe enough to preclude meaningful histologic examination. body at the scene and postmortem handling of the body was not
Forty-one cases were identified, of which 40 were included in always disclosed.
the study. In 1 case, a deceased dog found in an abandoned resi-
dence was eliminated because necropsy revealed thin (Purina
Statistical Analysis
score, 3 of 9) but not emaciated body condition; as there was
no other evidence of disease, it was concluded that dehydration All data analyzed were categorical and thus summarized with
led to the dog’s death, not emaciation. percentages. Comparisons between diseased and SEC dogs
were made through Fisher exact test, since at least 1 cell in all
comparisons had an expected number <5. Dogs with missing
Case Review
data for particular variables were omitted from analysis involv-
At the end of the study period, all submission information, ing those variables. Statistical tests were performed with Statis-
necropsy photographs, necropsy reports, and histologic sec- tix 9 (Analytical Software, Tallahassee, Florida). P  .05 was
tions were reviewed by 1 author (J.A.G.) or 2 (J.A.G., considered significant.
S.P.M). Review of all tissue sections was conducted prior
to review of other case materials such that the reviewing
pathologist was blinded to the necropsy findings. The under-
lying cause of death (COD) was determined by 1 author
Results
(J.A.G.) in consultation with the others and based on the Forty-one cases of emaciated dogs submitted by or on behalf
sum of law enforcement findings, medical history (if any), of a humane agency with the suspicion of starvation were
necropsy, histologic examination, and ancillary laboratory identified in the study period. Forty cases were included in the
tests. A COD of SEC was rendered when there was no gross study. In 7 cases, the necropsy was conducted at the CU-
or histopathologic evidence of disease that could account for AHDC. For 33 cases, tissue samples collected at necropsy,
emaciation. Any discrepancies between the initial gross or accompanied by photos of the necropsy (not available for
histologic interpretations and those at the time review 1 case), were submitted to the CU-AHDC. Necropsies were
(J.A.G.) were resolved by a third evaluation (S.P.M.) to performed by a variety of veterinarians, including referring
arrive at a consensus diagnosis. veterinarians (1 case), veterinarians whose practice is limited
For each case, the submitter’s geographic location and the to forensic medicine and pathology (23 cases), or a board-
dog’s approximate age, breed, sex, neuter status, and BCS certified veterinary pathologist (16 cases). Thirty-three cases
were determined. For descriptive purposes, age was classified were from New York City, 6 cases from central New York
Gerdin et al 1089

State, and 1 from Florida. Of 40 dogs, 33 (82%) died of SEC Table 1. Prevalence of Clinical, Gross, and Histopathologic Findings
and 7 (18%) died of disease. in Emaciated Dogs Grouped According to Cause of Death, No. (%).

SEC Disease
Circumstances Descriptive characteristics
Two circumstances occurred exclusively in association with BCS 1 26/33 (79) 6/7 (86)
dogs that died of SEC: death inside a vacated residence (5 cases) BCS 2 7/33 (21) 1/7 (14)
Euthanizeda 4/33 (12) 4/7 (57)
and death during extreme weather (8 cases). Extreme weather
Sex
included below-freezing temperatures (5 cases), hot weather (2 Male 16/33 (48) 6/7 (86)
cases), and hurricanes (1 case). In 1 case of hot weather, the body Female 17/33 (52) 1/7 (14)
was found in an abandoned apartment, and in 1 case during cold Neutered (male and female) 6/33 (18) 1/7 (14)
weather, the location of the body was not specified. In the case of Age, y
the dog found deceased outside shortly after a hurricane, 2 other <1.5 10/33 (30) 2/7 (29)
dogs were found alive in the same yard, and the deceased dog >1.5 23/33 (70) 5/7 (71)
Breed
showed no postmortem evidence of drowning.
Small 9/33 (27) 2/7 (29)
Large 11/33 (33) 3/7 (43)
Descriptive Characteristics Pit bull type 14/33 (42) 2/7 (29)
Gross and histologic findings
Descriptive characteristics are summarized in Supplemental Matted hair (long haired dogs) 3/6 (50) 0/0 (0)
Table 1. The median BCS was 1. There were 0 puppies Pressure point callus 8/18 (44) 1/7 (14)
<3 months of age, 1 older puppy, 11 young adult, 19 adult, and Trauma 6/32 (19) 0/7 (0)
Absence of subcutaneous fat 31/32 (97) 5/6 (83)
10 geriatric dogs. Of the 7 dogs with disease, 2 had endogenous
Serous atrophy
causes of starvation (megaesophagus and masticatory muscle Omentum 25/28 (89) 6/7 (86)
fibrosis). Perirenal 22/22 (100) 1/1 (100)
Eight dogs were euthanized, 30 were found dead, and 2 died Epicardial 28/30 (93) 4/6 (67)
within 3 days of being surrendered or confiscated. These 2 Bone marrow 20/25 (80) 2/3 (67)
cases of spontaneous death in custody were diseased dogs. Dermatitis 13/28 (46) 4/6 (67)
Euthanasia in custody occurred either within hours of assess- Atrophic skin changes 11/22 (50) 4/7 (57)
Demodex canis 1/25 (4.0) 2/6 (33)
ment or after weeks of care (Supplemental Table 1). Of the 8
Food and seminutritious items 11/33 (30) 0/7 (0)
dogs that were euthanized, 5 were promptly euthanized in Foreign material
extremis (eg, recumbent); 2 were euthanized due to lack of Inorganic 15/33 (45) 1/7 (14)
response to weeks of intensive care; and 1 was promptly eutha- Organic 5/33 (15) 1/7 (14)
nized due to human-directed aggression. In 4 of the 8 eutha- Stomach emptya 10/33 (30) 6/7 (86)
nized dogs, the underlying COD was SEC. Gastric petechiae/ecchymoses 9/27 (33) 1/7 (14)
SEC and diseased dogs did not differ significantly in BCS, Gastric atrophy/ulceration 21/31 (28) 1/5 (20)
Melena 21/31 (68) 1/5 (20)
sex, neuter status, age category, or breed category (Table 1).
Severe dental disease 1/33 (3.0) 1/7 (14)
Dogs with disease were significantly more likely to have been Zymogen depletion 7/28 (25) 3/6 (50)
euthanized than those with SEC, which most often were found Splenic hemosiderophages 23/25 (92) 6/6 (100)
deceased by law enforcement officers or third parties or were Hepatic cellular or lobular atrophy 17/31 (55) 4/7 (57)
presented deceased to a veterinarian or animal shelter Testicular atrophy 3/4 (75) 2/2 (100)
(P ¼ .008). Pit bull–type dogs composed a majority (40%) of Thyroid gland atrophy 11/13 (85) 2/3 (67)
the population, with fewer large-breed (32.5%) and small- Abbreviations: BCS, body condition score for dogs (Purina system21); SEC,
breed dogs (27.5%). starvation due to exogenous circumstances.
a
P  .005.

Gross and Histopathologic Findings meat by the owner; 1 was fed by the shelter staff; and in the
In 5 of the 7 cases where disease was the COD, disease remaining 2 cases, food was obtained from unknown sources.
involved the gastrointestinal (GI) tract (Supplemental Table The stomach of SEC dogs frequently contained food
1). Significantly more diseased dogs had an empty stomach (eg, kibble, meat, rice), marginally nutritious items (eg, bones,
compared to SEC dogs (Table 2; P ¼ .02). All dogs that had packets of ketchup), inorganic foreign material (eg, rocks, bits
food in their GI tract were SEC dogs: 11 of 33 SEC dogs had of plastic, razor blades), organic matter (eg, plant matter, hair),
digesta in the GI, and 7 of those 11 had food in the stomach spe- and combinations of these materials (Table 1). Melena (Fig. 1),
cifically. The presence of food in the GI was not significantly gastric ulcers, and gastric mucosal petechiae and ecchymoses
associated with the COD or euthanasia, however. Of the 7 dogs (Fig. 2) were frequently noted alone and in combination in
with food in the stomach at necropsy, 4 were alive at the time of both SEC and diseased dogs. Out of 36 dogs for which data
surrender or confiscation. Of these 4 dogs, 1 was fed bones and were available, 11 (31%) had 1 or more of these lesions.
1090 Veterinary Pathology 53(5)

Table 2. Suggested Procedures in the Postmortem Evaluation of an Emaciated Dog.

 Obtain perpendicular and oblique photos of the body in dorsal and right and left lateral recumbency. Document visibility of bony
prominences, including ribs, pelvis, vertebral transverse processes, scapula, and femur. Shaving severely matted dogs and wetting the fur of
long-haired breeds may be needed to reveal bony prominences.
 Document the location and relative amount of adipose tissue in the subcutis, omentum, perirenal tissue, epicardium, and femoral bone
marrow. Optionally, also determine body condition score using published scale.
 Open and examine the entire digestive tract from oral cavity to anus, including teeth, tongue, muscles of mastication, liver, gall bladder
(testing patency), and pancreas.
 Quantify the amount, type, quality, and location of the gastrointestinal contents, noting where there are none. Consider collecting samples
for feed or toxicologic analysis. Sieve stomach contents to identify foreign material.
 Record the body weight, and calculate the percentage loss of body weight, based on an estimated ideal weight or recorded antemortem
weight.
 Examine histologic sections as needed—including the gastrointestinal tract, liver, kidney, and femoral bone marrow—to establish or rule out
other causes of death.
 Determine the cause of emaciation.
 Determine the underlying cause of death.

Although melena was often found in association with ulcera- Discussion

tion, ulceration was not always present, and melena was not
We investigated the circumstances, descriptive characteris-
significantly correlated with it. Two of the 5 cases associated
tics, and gross and histopathologic findings of 40 dogs that
with extremely cold temperatures had gastric petechiae/ecchy-
were emaciated and suspected to have been starving. Dis-
moses, out of a total of 11 dogs with this lesion. There was no
eased dogs were significantly more likely than SEC dogs
significant correlation between dogs exposed to cold weather
to have an empty stomach. We found no other statistically
and gastric petechiae/ecchymoses.
significant differences in circumstances, descriptive charac-
Mild to moderate GI parasitism was seen at necropsy in 1
teristics, or gross or histopathologic findings of dogs that
diseased dog (Ancyclostoma sp) and 1 dog that died of SEC
died of SEC versus disease.
(Dipylidium caninum). Toxocara spp were detected in tissue
Dogs with disease were significantly more likely to have
sections in 1 other dog that died of SEC. Severe dental dis-
been euthanized compared to dogs that died of SEC. We sus-
ease—in the form of abrasion, tooth loss, and fractured
pect that this occurred because of case selection bias. When
teeth—was noted in 2 dogs, one of which was euthanized with
dogs are confiscated alive and emaciated, dogs with clinical
a stomach full of food and the other of which died with an
signs of disease or dogs that fail to gain weight are more likely
empty stomach.
to be euthanized. In contrast, dogs that gain weight with refeed-
Gross absence of fat and/or histopathologic evidence of ser-
ing alone and have no clinical signs of disease are not usually
ous atrophy of fat of the subcutis, omentum, perirenal area, epi-
submitted for necropsy, even if they are ultimately euthanized
cardium, and bone marrow was noted in a majority of cases,
for nonmedical reasons.
with comparable frequency in both SEC and diseased dogs
Among dogs in which the weather was suspected by the sub-
(Table 1). There was no significant difference between SEC
mitters to have played a role in death, most dogs died outside
and diseased dogs in depletion of fat stores in any location.
during very cold weather. This may be a reflection of the com-
Gross and/or histopathologic evidence of dermatitis was
paratively mild summers in the area from which our study dogs
noted occasionally in both SEC and diseased dogs. Demodex
originated, or it may stem from physiology—it is likely easier
canis was frequently noted in diseased dogs and rarely in SEC
for emaciated dogs to keep cool in the heat than to keep warm
dogs, although the difference was not significant. Atrophic
in the cold. Further studies from different geographic regions
changes in the skin—specifically, follicular miniaturization
might further elucidate the relationship among emaciation,
with telogen dominance, sebaceous gland miniaturization, and
death, and exposure.
epidermal atrophy with mild to moderate orthokeratotic hyper-
Diseased dogs were significantly more likely to have an
keratosis—were typically seen concurrently and with compara-
empty stomach than dogs that died of SEC. Most diseased dogs
ble frequency in both SEC and diseased dogs (Figs. 3, 4).
were probably unwilling to ingest food, as loss of appetite is a
Splenic hemosiderophages were noted in the majority for
hallmark of cachexia. Two diseased dogs were unable to ingest
which a histologic section of the spleen was available, and they
(masticatory muscle fibrosis) or digest (megaesophagus) food.
occurred with nearly equal frequency in SEC and diseased dogs
In contrast, the presence of material in the stomach of SEC dogs
(Table 1). Hepatocyte and/or hepatic lobule atrophy (Fig. 5),
demonstrates both a willingness and an ability to ingest mate-
thyroid gland atrophy (Fig. 6), and testicular atrophy were
rial—any material—including food, marginally nutritious items
noted often in both SEC and diseased dogs. Pancreatic zymo-
(eg, garbage), and various nonnutritious organic and inorganic
gen granule depletion was no more frequent in diseased dogs
materials. Thus, the presence of material in the stomach is an
versus SEC dogs or in dogs with an empty stomach versus dogs
important and informative necropsy finding. Gastric inorganic
with food in the stomach.
Gerdin et al 1091

Figures 1–6. Starvation of exogenous causes, dogs. Figure 1. Case No. 15. The stomach contains a mix of digested blood and miscellaneous
materials. Figure 2. Case No. 35. A dozen dark red to black mucosal ecchymoses are scattered along the greater curvature of the stomach.
Figure 3. Case No. 27. Atrophic changes in the skin include reduction of the epidermis to a single-cell layer, mild orthokeratotic hyperkeratosis,
miniaturization to absence of sebaceous glands, and telogen dominance. Hematoxylin and eosin (HE). Figure 4. Case No. 27. Sebaceous glands
are reduced to a few cells. HE. Figure 5. Case No. 36. Hepatic lobular atrophy, evidenced by closely spaced portal tracts and central veins.
Hepatocytes are atrophied (top inset) compared to normal hepatocytes (bottom inset). HE. Figure 6. Case No. 5. Thyroid follicles are diffusely
small and contain little to no colloid. Remaining colloid is floccular to granular. HE.
1092 Veterinary Pathology 53(5)

foreign material has been documented in dogs that died of We presume that most of the observed skin changes in these
SEC,30,39 and our findings further support these observations. cases ultimately result from chronic, severe caloric and protein
Food was found in the GI tract of 11 of the 33 SEC dogs. The deficits, mediated in part by concomitant endocrine changes.
fact that digesta was found in the stomach in 7 of these 11 cases Hair is 95% protein, and hair growth and keratinization can
suggests that the dogs were fed within a few hours of death, account for up to 30% of an animal’s daily protein require-
given the average gastric emptying time in dogs.2,37 At first ment.15 Sebum is lipid rich and thus also profoundly affected
glance, it might seem counterintuitive that a starving dog would by diet. In fasting people, sebum composition changes in a few
have food in its stomach; however, dogs may be given food by 1 days and explains the dull hair and flaky skin noted grossly in
or more people around the time of confiscation (J.A.G., R.R., starved individuals.5,8,34 Starvation results in endocrine
personal experience). First, owners often feed their animals changes,7,12 and while the endocrine changes that occur in dogs
when law enforcement officers arrive on the scene, in an effort experiencing prolonged negative energy balance are unknown,
to demonstrate compliance with the law. Second, law enforce- we assume that they have some effects on the skin. A con-
ment officers and shelter staff will often feed emaciated dogs founding effect in this retrospective study was the lack of stan-
treats or meals at the scene, upon transport or intake at a shelter, dardization and frequent lack of information regarding of the
or just prior to euthanasia, for various reasons (eg, enticement anatomic site from which samples of skin were obtained.
into or out of kennels). It may be warranted to state plainly in the We regularly observed atrophic changes in the liver, tes-
necropsy report that the presence of food in the stomach in an ticles, skin, and thyroid gland, as well as large numbers of
emaciated animal is not proof that a diet of sufficient quality splenic hemosiderophages, in both SEC and diseased dogs.
or quantity was being provided on a regular basis. The finding of atrophy in some organs (liver, testicles) was
An emaciated animal that dies or is found deceased with a somewhat unsurprising considering the fact that these
GI tract containing food, especially in normal to large amounts, lesions have also been noted to accompany negative energy
raises the suspicion of refeeding syndrome. Refeeding syn- balance and emaciation in a variety of species.26 Splenic
drome is an assortment of subclinical to fatal metabolic distur- hemosiderophages have been noted in starved reindeer,
bances that can occur in the first few days to weeks after although their pathogenesis and significance are unknown.18
implementation of nutrition in the chronically undernour- While pancreatic zymogen granule depletion— a change
ished.33 The phenomenon is well characterized in people and noted in starved rats19— was noted in almost a third of the
typically involves abnormalities in phosphorus, magnesium, dogs, the presence or absence of this finding should not be
other electrolytes, or thiamine, resulting in fatal cardiovascular, considered diagnostic, as postmortem studies have shown
neuromuscular, or respiratory compromise.38 Refeeding syn- that the pancreas of dogs autolyzes unpredictably and
drome occurs in undernourished horses42 and has been docu- unevenly, even in experimental conditions.10
mented in 1 cat3 and in dogs under artifactual experimental Given these and previous findings, we suggest certain pro-
conditions,20 but no clinical cases of refeeding syndrome in cedures for the postmortem evaluation of an emaciated animal
dogs have been documented. Ascribing COD to refeeding syn- (Table 2). The difference between a dog’s ideal body weight
drome in a dog should thus be done with extreme caution, espe- (BW) and weight at the time of necropsy is of keen interest
cially in postmortem cases with a lack of clinical data. to the courts. Consulting with a clinical veterinarian or breeder
Although gastric ulcerations, petechiae/ecchymoses, and may help establish an approximate ideal weight. Ideally,
melena have been noted in SEC dogs28,30 and although mice, individual-specific information, such as a photograph or med-
rats, and pigs are known to develop gastric ulcers during star- ical record, is used to establish prior BCS or weight.
vation,32,19,35 the pathogenesis and significance of these lesions The duration and completeness of starvation are also of
are unclear. Decreased cell turnover, decreased trophic factors, interest to the courts. These questions are impossible to answer
stress, and ingestion of foreign material may compromise GI on the basis of postmortem diagnostics alone, in which only
epithelial barrier function, leading to ulcerations and melena. BCS and final BW are known. Furthermore, they are—if not
In addition, gastric petechiae/ecchymoses may be seen in peo- impossible—exceedingly difficult to answer with even a mod-
ple who have died of hypothermia, but we found no significant est degree of medical confidence even when clinical data (eg,
correlation between dogs exposed to cold weather and gastric recorded weight) and husbandry information are available.
petechiae/ecchymoses. Answers to these questions depend on starting BW, body fat
The combination of histopathologic atrophic changes in the percentage, caloric intake, available water, exercise, ambient
skin common to both SEC and diseased dogs is unique and dis- temperature and calories needed to thermoregulate, and many
tinct from those seen in association with endocrinopathies. other often unknowable factors, including individual-specific
Although epidermal and follicular atrophy, telogenized hairs, differences in physiology and metabolism.
and hyperkeratosis are features seen in hyperglucocorticoid- Unfortunately, no information was available for any of our
ism, hypothyroidism, and other endocrinopathies, other diag- cases regarding the length of time that the dogs starved or how
nostic features of these endocrinopathies were absent—such completely they starved (zero caloric intake versus some calo-
as follicular hyperkeratosis and mineralization of the external ric intake). However, information gleaned from the literature
root sheath (hyperglucocorticoidism) or epidermal and follicu- can aid the pathologist in drafting informative comments for
lar infundibular hyperplasia (hypothyroidism). the court. Clearly, survival time for complete starvation is
Gerdin et al 1093

heavily dependent on initial BCS / percentage body fat. In peo- the tissues collected for histopathologic examination. The low
ple, death can occur when 35% to 50% of ideal BW is lost,25 number of diseased dogs also limited the power of statistical
and some published data on emaciated dogs suggests a similar analyses, and only 5 of the 7 diseased dogs were likely cachec-
range.36 Various poorly controlled and often terminal studies tic. It would be interesting to compare the gross and histopatho-
from the early 20th century showed that dogs with zero caloric logic findings in cachectic dogs with SEC dogs, especially in
intake and free access to water may be moribund or die in as light of the fact that gross and histopathologic changes accom-
few as 15 days (47% loss of BW) or survive for 117 days or lon- panying cachexia have not been described in dogs, despite the
ger (62% loss of BW).23 Later better-controlled nonterminal fact that cachexia is a clinically significant syndrome responsi-
experiments showed that dogs given only water but no food for ble for much morbidity and mortality.14 Prospective studies of
2 weeks lost between 11% and 15% of initial BW.22 A similar blood chemistry and body composition changes in emaciated
study in which dogs were given only water for 3 weeks showed dogs receiving nutritional support could shed light on the
an average 18% loss of initial BW by nonobese dogs and 24% changes, if any, which occur during refeeding. Finally, studies
loss by obese dogs.6 similar to this are needed for other species, as dogs are not the
The effects of dehydration are more difficult to assess. Post- only animals subject to starvation.
mortem evaluation of dehydration rests in part on qualitative In summary, emaciated dogs suspected of being starved
changes such as dry and tacky mucous membranes, reduced have gross fat and muscle wasting and often have serous atro-
skin turgor, wrinkled skin, and sunken eyes, the last 3 factors phy of omental, perirenal, epicardial, and bone marrow fat. A
of which are strongly influenced by the relative abundance of variety of usually adult to geriatric small- and large-breed
local fat deposits. Also, decomposition, autolysis, and postmor- dogs—most frequently, pit bull–type breeds—may present for
tem dehydration of the body may significantly alter these para- emaciation. In the majority of cases, the COD is SEC, with a
meters. There are reports in the literature of 6 dogs deprived of minority due to endogenous disease, usually of the GI tract.
both food and water, with 1 death at 11 days (33% BW loss), 4 Being found in a vacated residence, death during temperature
dogs that survived 14 to 15 days (3 dogs lost between 22% and extremes or severe weather, severe hair matting, and traumatic
25% BW; 1 was moribund with a 33% BW loss), and 1 dog that injuries were each associated exclusively with SEC. Diseased
was still alive at 20 days (35% BW loss).9,17 For the 33 cases of dogs had an empty stomach significantly more often than SEC
SEC in our study, we believe that the primary COD was starva- dogs, which frequently had food and/or foreign material in the
tion, not dehydration. Based on basic physiology and some stomach. Both groups often had gastric petechiae/ecchymoses
experimental evidence,1 death due to dehydration occurs and melena. Histopathologic lesions commonly found in all
before the extreme loss of fat (BCS 1 and 2) and muscle (BCS emaciated dogs included atrophy of the liver, skin, thyroid
1) that defines emaciation. However, we cannot be certain that gland, and testicle, as well as splenic hemosiderophages.
terminal dehydration played no role in death once an emaciated
state was reached. Acknowledgement
In people, comparing morphometric measurements (eg, We thank Dr Jeanine Peters, DACVP, DACVD, for her evaluation of
femur length) and organ weights to a reference population are the histopathologic changes in the skin.
a cornerstone of the diagnosis of starvation, especially in
infants and children, whose growth is stunted from chronic Declaration of Conflicting Interests
undernutrition.25 With the possible exception of Beagles,4,24 The author(s) declared no potential conflicts of interest with respect to
adoption of these practices for dogs is problematic, given the the research, authorship, and/or publication of this article.
limited amount of published information available on canine
morphometrics, growth, and organ weights13 and the profound Funding
effect that breed, sex, and age have on these parameters.16,40 In The author(s) received no financial support for the research, authorship,
our population, death due to emaciation in dogs <6 months of and/or publication of this article.
age was uncommon (1 in 33 dogs).
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