Blood sugar in infantile gastro-enteritis

A survey of blood sugar levels in 868 infants with dehydration from gastro-enteritis is presented. The ages of the patients ranged from 2 to 35 months. In 7,9% of cases, blood sugar levels were 0 -50 mg/100 ml and in 10,2% they were over 200 mg/100 ml. Hypoglycaemia was more common in malnutrition, and a high mortality rate was found in patients with hypo- and hyperglycaemia. Hypothermia was associated with abnormal blood sugar levels. No correlation was found between blood sugar and serum sodium. Aetiology and treatment are briefly reviewed.

Bicarbonate excretion in kwashiorkor

Children with kwashiorkor have an impairment of bicarbonate excretion which may result in the inappropriate production of acid urine in the presence of systemic alkalosis. This defect has resolved after 2 weeks of treatment.

Specific protein assays in protein-calorie malnutrition

Assessment of serum protein concentrations in protein-calorie malnutrition was carried out by two specific immunochemical methods, the Single Radial Immunodiffusion technique and the Automated Immunonephelometric procedure. The correlation coefficient (r) between the two methods was above 0.85 for all the serum proteins assayed. The automated nephelometric assay procedure has the advantages that it is rapid and that a large number of samples can be readily processed. The system in its present form could not be readily used to quantitate proteins such as prealbumin whose serum concentration was less than 50 mg/100 ml. The single radial immunodiffusiton technique gave more consitent results for IgA estimation than the automated technique. With the exception of C4 and the immunoglobulins, all the serum proteins assayed were lower in children with protein-calorie malnutrition than in control children. During refeeding in children with protein-calorie malnutrition the first serum protein to show a significant rise was C3. This was followed by transferin, then prealbumin and lastly albumin. C4 did not show any significant change. In experimental protein-calorie malnutrition in rats, the first serum protein to show a significant reduction was C3. This was followed by transferrin and then albumin. On refeeding the rats these serum proteins returned to normal values in the same order.

Marasmic kwashiorkor anemia. III. Hemoglobin oxygen affinity

Oxygen-hemoglobin dissociation curve, 2,3-diphosphoglycerate (2,3-DPG), and adenosine triphosphate (ATP) have been studied in marasmic kwashiorkor before re-feeding, after re-feeding, and in control children. P 50 and 2,3-DPG level are normal on admission, but high after re-feeding. Patients studied on admission were separated into 2 groups according to whether they presented active erythropoiesis (group I) or erythroblastopenia (group II). In group I, the sum 2,3-DPG + ATP correlates with the hemoglobin level. In group II, the sum 2,3-DPG + ATP correlates with the blood pH but not with the hemolobin level. It is suggested that marasmic kwashirokor anemia is an adaptation to a reduced metabolic activity. The hematological picture could proceed in 2 stages in this disease. In a first stage, the erythropoiesis is normal or increased because of the existence of a decreased red cell life span; a low hemoglobin level is observed, but there is no apparent hypoxia. At a more advanced stage of the disease, the tissue metabolism falls dramatically, the erythropoiesis is no loner stimulated, and the erythrocyte volume decreases notably.

A critical review of the clinical relevance of growth hormone and its measurement in the nuclear medicine laboratory

A wide variety of metabolic and stressful stimuli, both physical and psychologic, produce rapid elevation of plasma growth hormone (GH). In addition, spontaneous elevation of GH occurs during the day, and a rise in GH occurs in association with the initial slow-wave sleep episode at night. Although the identity of the long-sought GH releasing factor has not yet been established, a hypothalamic factor inhibiting GH release named somatostatin has been identified and synthesized. Most, if not all, of the GH rises are mediated by neural mechanisms, and therefore they may be disrupted by many disease processes affecting the pituitary or the hypothalamus...

Dual significance of hepatic cholinesterase as an index of liver involvement and state of protein-calorie malnutrition

159 cases of different forms of PCM (K.W.O., marasmic K.W.O., marasmus & nutritional oedema together with 20 cases normal healthy controls were selected. Serum, red blood cells and liver cholinesterases were estimated together with serum total protein and serum albumin. Pathological liver examination was done for every case, some cases from each group were followed-up till clinical recovery and the same investigations were done to them. The results indicate that the serum and hepatic pseudo-cholinesterase activity parallels directly the serum albumin (not the total proteins) as well as the pathological changes in the liver. The diminution in enzymatic activities and serum proteins coincides with the severity of the liver affection in the various forms of PCM. Insignificant change in true cholinesterase was demonstrated in all cases studied. Follow-up studies in a number of cases till clinical recovery revealed the return to normal of enzymatic activity and serum albumin is concomitant with restoration of normal pathological liver finding. The significance of changes in serum and liver cholinesterase activities as indices of the extent of liver involvement as well as their diagnostic and prognostic values was discussed.

Biochemical and haematological aspects of anaemia associating protein energy malnutrition (PEM)

Haematological as well as biochemical parameters assessing anaemia associating protein energy malnutrition PEM were estimated. Data revealed that controls studied have a relatively lower Hb, Ht, and R.B.C.S. count than European standards. Hypochromic anaemia was predominant in 83.3% of moderate Kwashiorkor being normocytic in 50% and microcytic in 33.3%. In severe KWO anaemia was normocytic in 42% and microcytic in 19.2%. Normochromia was found in 9.7% and hypochromia in 29%. Macrocytosis was found in 38.8% in severe KWO. In marasmus, normocytic anaemia was revealed in 74% of the 2nd. grade being normochromic in 82% and hypochromic in 40%. Macrocytic anaemia was detected in 26%. In 3rd. grade subjects normocytic normochromic anaemia occurred in 70% of the cases. Macrocytosis was encountered among 30% of the cases. Serum iron and transferrin level dropped in both KWO and marasmus, the extent of decrease was greater in the former. The percent transferrin saturation was elevated in severe cases. Particularly severe KWO and marasmic KWO.

In vitro uptake of labeled amino acids by red blood cells of children with protein-calorie malnutrition

The in vitro uptake of 14C-glycine, 14C-leucine and 35S-methionine by red blood cells as well as the red blood cells and plasma amino acid patterns were studied in 20 children with protein-calorie malnutrition. Blood samples were obtained from each patient on admission, following clinical recovery and, when possible, several months later. Amino acid uptake as well as levels of red blood cells and plasma amino acids are quantitatively changed in protein-calorie malnutrition. Significantly increased uptake of 14C-glycine but decreased uptake of 14C-leucine and 35S-methionine were observed in patients on admission. Following clinical recovery the uptake values of all three amino acids were markedly reduced to levels significantly below normal. Several months later values for glycine and leucine uptake were found to be normal. No significant correlation, however, was found between glycine, leucine, or methionine uptake values and concentrations of these amino groups in RBCs or plasma of patients. It is concluded that the elevations observed in red blood cell amino acids of protein-calorie malnutrition patients are not purely a result of increased amino acid uptake of RBCs and that normalization of both amino acid uptake values and their concentrations in RBCs require longer than the treatment period.

Chemically defined diet in the treatment of kwashiorkor

Kwashkorkor is associated with malabsorption of energy and nutrients. Standard diets often initiate diarrhea and a high mortality is still prevalent. A synthetic monomolecular formula has been evaluated and compared with a standard diet in the early rehabilitation phase of 21 children with kwashiorkor. The formula group had significantly less vomiting and reached minimum weight faster than the group on standard diet. Weight gain and diarrhea were similar. The rise of albumin and BUN was faster on standard diet. A significant increase in haemoglobin was seen only in the formula group. A rise in body temperature after a meal was evident in most patients and significantly more pronounced in the formula group. The lower total nitrogen content of the formula may explain the observed slower rise in albumin and BUN but the ready utilization was indicated by the favourable weight changes as well as the rise in rectal temperature. As high energy per volume was desirable the formula was not diluted to isoosmolality. However, the high glucose concentration in the experimental diet probably caused some negative effects.

Serial measurements of vitamin B-12 and vitamin B-12-binding capacity in marasmic kwashiorkor

Vitamin B-12 and total vitamin B-12-binding capacity (TBBC) have been determined by a radio-saturation assay in the blood of a large group of patients suffering from marasmic kwashiorkor on admission, and during their whole re-feeding. The results have been compared with values obtained in control children of the same ethnic group and with normal children living in Belgium. Vitamin B-12 levels are high on admission and only normalize during the second month of re-feeding. TBBC is normal on admission but significantly increases during re-feeding.

Total body potassium and serum electrolyte concentrations in protein energy malnutrition

The total body potassium (TBK) and serum electrolyte concentrations of malnourished children in Cape Town are similar to those in Jamaica. The TBK is almost always low and hyponatraemia is common, but there was no relationship between the TBK and serum Na and K concentrations. These abnormalities, particularly a very low TBK, appear to influence the prognosis. The expression of the observed TBK as a percentage of the expected value for a normal child, of the same weight and height, appears to be a useful index of the severity of the total body potassium deficit.

Lysozyme activity in plasma and leucocytes in malnourished children

1. Lysozyme activity was estimated in plasma and leucocytes of twelve children suffering from kwashiorkor, thirteen children with ocular signs of vitamin A deficiency and ten apparently normal children acting as controls.

2. The results showed that the activity of lysozyme in leucocytes was significantly reduced in children with kwashiorkor and in vitamin A-deficient children. Following therapy, the levels of the enzyme in leucocytes were restored to normal.

3. The initial enzyme activity in the plasma of both groups of children did not differ significantly from the control value, and was not significantly changed after treatment.

4. It is suggested that the decreased activity of lysozyme is one of the factors responsible for diminished resistance to infection generally observed in malnourished children.

Platelet adhesiveness, plasma free fatty acids, and serum triglycerides in kwashiorkor

The concentrations of plasma free fatty acids and triglycerides were studied in 15 cases of kwashiorkor and in 14 normal controls in relation to the degree of platelet adhesiveness. A significant rise in the level of free fatty acids was found which correlated with a significant increase in platelet adhesiveness in these cases.