The relation of oedema to serum protein and pseudocholinesterase levels in the malnourished infant

Abstract

The extent of clinical oedema in 200 Jamaican cases of infantile protein malnutrition has been compared with the levels of serum proteins and serum pseudocholinesterase activity and with the degree of hepatomegaly. Two separate analyses were made, oedema being assessed clinically and by the amount of initial weight loss during recovery. In both analyses there was significant correlation between the degree of oedema and the values of serum albumin and total protein. Cases with severe oedema consistently had low serum proteins, but only about ha-lf of the cases with very low proteins had severe oedema. Both hepatomegaly and low serum pseudocholinesterase activity were significantly related to severe oedema. On the other hand there was no evidence of correlation between liver dysfunction and liver size except in the largest livers. Mortality was highest in cases with severe oedema and very low serum proteins. Liver enlargement and very low serum pseudocholinesterase levels were more constant features of fatal cases, with or without oedema. The possible mechanisms of oedema in kwashiorkor, and the significance of the fatty liver, are briefly discussed.