The Serum Chemistry in Uncomplicated Kwashiorkor

Although the literature of kwashiorkor is now reaching large dimensions, few studies of the serum chemistry have so far appeared.The published results are difficult to summarize.There has been up to now no general agreement on diagnostic criteria, and the name kwashiorkor or one of its synonyms has undoubtedly been applied to diverse conditions arising from various causes in different parts of the world (Waterlow, 195 I).A biochemical investigation was undertaken to characterize the condition of children admitted to Mulago Hospital, Kampala, between May and December 1951 with the diagnosis of kwashiorkor and to follow the effect of treatment.As already indicated (Trowell, Davies & Dean, 1952) the disease as it is seen at Mulago is often complicated by other illness.It was, however, possible to select a group of children in whom the state of malnutrition was dominant, and the results to be described were obtained from this group. Values found by previous investigatorsSerum proteins.There is general agreement that the total serum proteins are reduced in active kwashiorkor, whatever the home diet of the children may have been, Uncertainties and variations of method reduce the comparative value of reports which do not contrast findings at the beginning and end of treatment.The fourteen children with fatty-liver disease investigated by Waterlow (I 948) in the West Indies had total serum proteins ranging from 3.1 to 6.4 g/Ioo ml., with an average of 4 5 g.After about 5 weeks' treatment with milk, the totals reached between 6-0 and 7-0 g/Ioo ml. in four children.Altmann (1948), working in Johannesburg, found an average of 4 2 g total protein/Iooml. in twenty freshly admitted children, and an albumin : globulin ratio of unity.Eleven children had on discharge serum proteins which averaged 7.0 g/Ioo ml., with an average ratio of 1.5.I n a later series (Anderson & Altmann, 1951) these findings were on the whole confirmed, and further improvements of total protein and albumin : globulin ratio were noted after successful treatment.An electrophoretic examination of serums taken from children who were acutely ill showed that the y-globulin was absolutely and relatively high, and albumin was low; dc-and P-globulins were perhaps slightly higher than normal.Janssen & le Roux (1950) found an average of about 4-1 g total protein/Ioo ml. and an albumin : globulin ratio very near unity in forty-one children admitted to a Pretoria hospital.Treatment raised the average value for twenty-four children to about 6.5 g/Ioo ml. and the albumin : globulin ratio to about 1.5.Thirty-two children in Curaqao investigated by Van der Sar (1951) had an average of q.2 g total