The Serum Chemistry in Uncomplicated Kwashiorkor

Abstract

The literature on serum chemistry in kwashiorkor is reviewed. The children studied were among those, mainly Baganda, who were admitted to hospital in Kampala and for whom breast feeding had probably lasted 6 to 8 months and had been followed by a quick change to an ordinary adult diet, with signs of ill health appearing early in the second year of life. Adult foods consist mainly of cooked banana and sweet potato, these being at times replaced by maize and cassava, with small anounts of groundnut, butter bean and cowpea anc some Amaranthus as green vegetable. It seems likely that the protein intake by the child in ea: ly life is between 10 and 15 g. daily. The basis of selection of the patients is described. Treatment was with a diet low in fat, 2 to 3 g. daily and high in protein, 60 to 100 g. daily, this latter being derived from cow's milk. Serum analyses were nade at the beginning of treatment in the numbers of cases indicated in brackets and were continued at 4-day intervals from the first until the fourth week of treatment. Total protein (33), average 3.98 per cent., rose to about 6 g. on the 8th and to a final value about 7 g. on the 21st day: albumin (18), average 1.51 per cent., with a final mean 3.6 per cent. was well below that usually accepted as normal globulin (18) had initially a mean of 2.44 per cent., but rose unexpectedly to an average of 3.6 per cent. : albumin: globulin ratio, however, also rose from 0.67 to slightly more than 1: urea (29) rose from an initial mean of 16.2 mg. to about 60 mg. without ill effect or any sign of N retention: total cholesterol (28) had a mean of 87 mg. per cent. and rose to nearly double by the 8th day, but fell progressively to about 140 mg. in the fourth week: alkaline phosphatase fell until the 12th day and rose steadily thereafter, while pseudo-cholinesterase, amylase and esterase activities increased steadily during treatment. Data for normal African children not being available, no conclusion can be drawn whether the increases observed are to " normal " or " super normal" levels but, in both the biochemical definition of kwashiorkor and the assessment of the value of treatment, serial estimations of total protein, albumin: globulin ratio, amylase and esterase are considered to be of value.-D. Harvey.