This state happens when intake < demands.

intake:

• Starvation (e.g. dysphagia and vomiting)
•   Improper digestion (Like in various GIT problems)
• Demands

As in hyperctabolic states (á BMR 25% above normal)

•   Postoperative
•   Severe sepsis (necrotising fascitis)
•   Severe trauma (burns)
•   Severe disturbances of major viscera (pancreatitis)
•   This results in utilization of body stores:

1- Carbohydrates:

Liver and muscle glycogen is broken down by adrenaline and glucagon to Glucose

2- Protein (muscle) breakdown resulting in a negative nitrogen balance.

•   Protein 
• a Liver à gluconeogenesis à Glucose
•   This is due to the effect of cortisol and glucagon
•   After esophagectomy a patient loses 90 g N/d eq to 2500 g muscle protein/d

3-            Fats à lipolysis à FA + glycerol                                Glycerol à Acetyl CoA à Kreb’s à ATP

  This is due to the effect of GH, glucagon and norepinephrine

  Gross changes, only in advanced stages:

•   Weakness
•   Weight loss
•   Lean and apathetic in post-traumatic cases
•   Superimposed flush over sunken eyes in hypercatabolic states